Oncological Outcomes and Prognostic Factors in Soft Tissue Sarcoma of Children, Adolescents, and Young Adults: A...

Background: Soft tissue sarcomas (STS) in children, adolescents, and young adults are rare and biologically heterogeneous, and prognostic factors for local recurrence, metastasis, and survival remain incompletely defined. This study aimed to characterize oncological outcomes and to explore clinical, surgical, and treatment-related factors associated with these endpoints at a tertiary sarcoma center. Methods: This retrospective single-center cohort study included 42 consecutive patients aged ≤25 years with histologically confirmed STS who underwent definitive surgery between June 2018 and November 2025. Local recurrence-free (LRFS), metastasis-free (MFS), event-free (EFS), and overall survival (OS) were estimated by the Kaplan-Meier method with competing-risks sensitivity analyses. Given the limited number of events, pre-specified univariable comparisons (log-rank, Fisher exact, Mann-Whitney U) were performed and regarded as exploratory. Results: The median age was 16.7 years and 26 patients (61.9%) were female. A microscopically complete (R0) resection was achieved in 35 of 41 patients with assessable margins (85.4%), and limb preservation in 38 (90.5%). Over a median follow-up of 23.1 months, the 24- and 60-month estimates were LRFS 85.7% and 79.6%, MFS 93.3% and 84.8%, EFS 82.3% and 64.7%, and OS 96.0% and 81.5%, respectively. Metastatic disease at diagnosis was the only variable associated with metastatic status at last follow-up (p = 0.035). No factor was robustly associated with local recurrence; anatomical site (p = 0.68), resection-margin status (p = 0.23), and tumor volume (p = 0.97) were not significant, and an apparent association with a sub-millimeter margin rested on a single event (complete separation). Conclusions: Metastatic disease at diagnosis emerged as the most important prognostic factor for MFS in our cohort. Despite the complexity of treatment in this young patient population, high rates of complete resection and limb preservation were achieved, highlighting the value of multidisciplinary management in specialized sarcoma centers. While the limited cohort size did not allow the identification of further statistically significant prognostic factors for local recurrence, such associations may become detectable in larger multicenter studies.