Survival and prognostic factors in extremity soft tissue sarcoma: a 36-year retrospective cohort study from a tertiary center in Ecuador

Background: In Latin America, research on soft tissue sarcomas (STS) has been predominantly descriptive, focusing on epidemiological and clinical-pathological characteristics. Objective: To evaluate long-term survival outcomes and identify prognostic factors in patients with extremity STS (eSTS). Design, Setting, and Participants: This was a retrospective cohort study analyzing 140 patient records diagnosed with eSTS at a Social Security Hospital in Ecuador between 1986 and 2020. Methods: Clinical, pathological, and treatment data were extracted from medical records. Survival rates were estimated using Kaplan–Meier methods. Univariate and multivariate Cox regression analyses were used to identify factors associated with overall survival (OS). Results: Among the 140 patients, the most common histological subtypes were liposarcoma, fibrosarcoma, and undifferentiated pleomorphic sarcoma. At diagnosis, 45% of tumors were clinical stage IA or IB. Upfront surgery was performed in 36% of patients; 31% required re-excision due to inadequate initial surgery, and 33% underwent resection for recurrent disease. At the end of follow-up, 116 patients (82.9%) were alive, and 24 (17.1%) had died. Estimated OS rates at 5, 10, 15, and 20 years were 71.3%, 61.9%, 41.3%, and 41.3%, respectively. In univariate analysis, clinical stage ( P = 0.002), histological grade ( P = 0.014), lymph node involvement ( P = 0.018), surgical margins ( P = 0.027), and adjuvant therapy ( P = 0.041) were significantly associated with OS. However, no independent prognostic factor was identified in multivariate analysis. Conclusions: This is the first long-term survival analysis of eSTS patients in Ecuador. Although several variables were associated with improved survival in univariate analysis, none remained significant in multivariate analysis. These findings highlight the importance of early-stage diagnosis and appropriate surgical management, while also underscoring the need for larger, prospective studies to validate prognostic indicators in this population.