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Pia Weskamp, Dominic Ufton, Marius Drysch, Johannes Maximilian Wagner, Mehran Dadras, Marcus Lehnhardt, Björn Behr, Christoph Wallner

• The diagnosis and prognostic outcome of STS pose a therapeutic challenge in an interdisciplinary setting. The treatment protocols are still discussed controversially. This systematic meta-analysis aimed to determine prognostic factors leading to the development and recurrence of STS. Eligible studies that investigated potential risk factors such as smoking, genetic dispositions, toxins, chronic inflammation as well as prognostic relapse factors including radiation, chemotherapy and margins of resection were identified. Data from 24 studies published between 1993 and 2019 that comprised 6452 patients were pooled. A statistically significant effect developing STS was found in overall studies stating a causality between risk factors and the development of STS (\(\it p\) < 0.01). Although subgroup analysis did not meet statistical significances, it revealed a greater magnitude with smoking (\(\it p\) = 0.23), genetic predisposition (\(\it p\) = 0.13) chronic inflammation, (\(\it p\) = 0.20), and toxins (\(\it p\) = 0.14). Secondly, pooled analyses demonstrated a higher risk of relapse for margin of resection (\(\it p\) = 0.78), chemotherapy (\(\it p\) = 0.20) and radiation (\(\it p\) = 0.16); after 3 years of follow-up. Therefore, we were able to identify risk and relapse prognostic factors for STS, helping to diagnose and treat this low incidental cancer properly.