Sex-associated differences in initial resection location, margin status, and re-excision in extremity leiomyosarcoma: a retrospective tertiary-center cohort study
- 1Department of Plastic Surgery and Hand Surgery, Burn Center, Sarcoma Center, BG University Hospital Bergmannsheil, Ruhr University Bochum
- 2Clinic for Plastic and Reconstructive Surgery, Agaplesion Diakonieklinikum Hamburg
Abstract
Background: Sex-associated differences in early surgical care may occur within individual sarcoma entities. We examined recorded tumor characteristics, initial resection location, margin status, and re-excision in extremity leiomyosarcoma.
Methods: This exploratory retrospective study included 79 patients with initial resection during 2000–2015 who ultimately received treatment at a tertiary sarcoma center. The primary endpoint was initial R1 versus R0 resection. Analyses used Firth penalized logistic regression and Bayesian marginal standardization; treatment-location, re-excision, and survival analyses were exploratory.
Results: Initial R1 occurred in 34/46 men (73.9%) and 13/29 women (44.8%; absolute difference 29.1 percentage points; P = 0.015). Men more frequently underwent initial outside-center surgery (72.3% vs. 41.4%) and re-excision (82.6% vs. 50.0%). Recorded tumors <5 cm were more frequent in men (64.6% vs. 35.5%). The male-sex odds ratio decreased from 3.41 (95% CI 1.31–9.24) after age and site adjustment to 2.43 (0.82–7.41) after additional size and depth adjustment. The fully standardized difference was 16.6 percentage points (95% credible interval −2.5 to 37.4), compatible with no difference as well as a clinically substantial difference. Among patients with known location and R0/R1 status, R1 occurred after 37/44 outside-center and 9/29 index-center resections. All 47 patients with initial R1 underwent re-excision; definitive R0 was achieved in all 79 patients.
Conclusion: Men in this selected, exploratory cohort had higher observed frequencies of outside-center resection, initial R1, and re-excision. Adjustment attenuated the association, with substantial residual uncertainty. These findings do not establish inequity, differential access, biological causation, or mediation and require prospective multicenter validation.
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BibTeX
@article{weskamp2026sexassociated,
title = {{Sex-associated differences in initial resection location, margin status, and re-excision in extremity leiomyosarcoma: a retrospective tertiary-center cohort study}},
author = {Pia Weskamp and Sonja Verena Schmidt and Marius Drysch and Felix Reinkemeier and Mehran Dadras and Marcus Lehnhardt and Flemming Puscz and Christoph Wallner},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1980400},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1980400/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Sex-associated differences in initial resection location, margin status, and re-excision in extremity leiomyosarcoma: a retrospective tertiary-center cohort study
AU - Pia Weskamp
AU - Sonja Verena Schmidt
AU - Marius Drysch
AU - Felix Reinkemeier
AU - Mehran Dadras
AU - Marcus Lehnhardt
AU - Flemming Puscz
AU - Christoph Wallner
PY - 2026
DA - 2026/10/19
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1980400
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1980400/full
AB - Background: Sex-associated differences in early surgical care may occur within individual sarcoma entities. We examined recorded tumor characteristics, initial resection location, margin status, and re-excision in extremity leiomyosarcoma. Methods: This exploratory retrospective study included 79 patients with initial resection during 2000–2015 who ultimately received treatment at a tertiary sarcoma center. The primary endpoint was initial R1 versus R0 resection. Analyses used Firth penalized logistic regression and Bayesian marginal standardization; treatment-location, re-excision, and survival analyses were exploratory. Results: Initial R1 occurred in 34/46 men (73.9%) and 13/29 women (44.8%; absolute difference 29.1 percentage points; P = 0.015). Men more frequently underwent initial outside-center surgery (72.3% vs. 41.4%) and re-excision (82.6% vs. 50.0%). Recorded tumors <5 cm were more frequent in men (64.6% vs. 35.5%). The male-sex odds ratio decreased from 3.41 (95% CI 1.31–9.24) after age and site adjustment to 2.43 (0.82–7.41) after additional size and depth adjustment. The fully standardized difference was 16.6 percentage points (95% credible interval −2.5 to 37.4), compatible with no difference as well as a clinically substantial difference. Among patients with known location and R0/R1 status, R1 occurred after 37/44 outside-center and 9/29 index-center resections. All 47 patients with initial R1 underwent re-excision; definitive R0 was achieved in all 79 patients. Conclusion: Men in this selected, exploratory cohort had higher observed frequencies of outside-center resection, initial R1, and re-excision. Adjustment attenuated the association, with substantial residual uncertainty. These findings do not establish inequity, differential access, biological causation, or mediation and require prospective multicenter validation.
SN - 2234-943X
ER -