Characteristics and Outcomes of Soft Tissue Sarcoma in Saudi Arabia: A 10-Year Experience

Soft tissue sarcomas (STS) are rare, heterogeneous malignancies representing less than 1% of solid cancers. Given the diversity of subtypes and the complexity of management, understanding regional epidemiological patterns is essential. This study aimed to evaluate the clinical characteristics, treatment strategies, and prognostic factors in STS patients in Saudi Arabia at a sarcoma center.

This retrospective study included 214 patients with STS treated between 2010 and 2020. Patient demographics, tumor characteristics, clinical stage, and treatment modalities were collected using REDCap. Overall survival (OS) was estimated using Kaplan-Meier curves, and prognostic factors were analyzed using Cox regression. Statistical significance was set at p < 0.05.

The median age at diagnosis was 37 years (IQR: 25-49.5), and the median symptom duration before diagnosis was 8 months. Synovial sarcoma (20%) was the most common subtype, followed by liposarcoma (13.6%) and undifferentiated pleomorphic sarcoma (12%). Metastatic disease at diagnosis was reported in 39% of patients, with the lower limb being the most affected site (62.1%). Local treatment included surgery alone (45.3%), radiation alone (7.5%), and combined surgery and radiation (41.6%). Median OS was not reached in localized disease, whereas it was 26 months in metastatic cases (p< 0.01). Age ≥65 years (hazard ratio[HR]: 6.05, p=0.002), larger tumor size (HR: 9.12, p=0.04), and metastasis (HR: 8.77, p<0.001) were associated with worse survival. Tumors in extremities (HR: 0.38, p=0.04) and combined local therapy (HR: 0.13, p=0.009) were associated with better OS. Multimodal therapy improved OS in metastatic cases (p=0.004).

STS in Saudi Arabia presents at a younger age, with prolonged symptom duration, and a high burden of metastatic disease. Despite these challenges, outcomes are comparable to global trends, particularly multimodal approaches. Future research should identify barriers to early diagnosis, improve healthcare access, and explore novel systemic therapies.