Clinicopathological Characteristics and Treatment Patterns of Extremity, Trunk, and Axial Sarcomas: A Descriptive Real-World Cohort Study from a Romanian Tertiary Oncology Center

Abstract

Background and Objectives: Sarcomas are rare malignancies of mesenchymal origin comprising less than 1% of all adult solid tumors, exhibiting marked histological heterogeneity and variable clinical behavior. Data from Eastern European tertiary oncology centers remain scarce. This study characterized the clinicopathological features, treatment modalities, and survival outcomes of patients with sarcomas of the extremities and trunk treated at the “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology from Bucharest over a ten-year period. Materials and Methods: We conducted a retrospective analysis of 164 patients diagnosed with sarcomas of the extremities and trunk between 2010 and 2020 at “Prof. Dr. Alexandru Trestioreanu” Institute of Oncology. Variables included age, sex, tumor localization, histological subtype, immunohistochemical profile, treatment modalities, recurrence, metastatic spread, and overall survival (OS). Kaplan–Meier curves estimated survival; log-rank tests were applied for subgroup comparisons. Results: The cohort comprised 82 males and 82 females (50.0% each), with a mean age of 48.8 ± 18.3 years. The lower limb was the most frequent site (n = 96, 58.5%), particularly the thigh/femur (34.1%). The most common subtypes were undifferentiated pleomorphic sarcoma (14.6%), osteosarcoma (12.2%), and fibrosarcoma (11.0%). Surgery was performed in 75.6%, chemotherapy in 80.5%, and radiotherapy in 59.8%. Local recurrence occurred in 35.4% and distant metastases in 41.5%. The median OS was 96.0 months (vital status known for 160/164 patients; 90 deceased, 70 alive; OS duration available in 126 patients). Metastatic disease was associated with shorter observed survival in descriptive Kaplan–Meier analysis (log-rank p < 0.001); this comparison is exploratory given the time-dependent nature of the variable. Survival ranged from 11.5 months (leiomyosarcoma) to 162.5 months (dermatofibrosarcoma protuberans) by histotype. Conclusions: This study provides clinically relevant epidemiological and survival data from Romania. The findings illustrate real-world heterogeneity of sarcoma presentations and outcomes at an Eastern European tertiary center and highlight the need for improved diagnostic standardization, prospective data collection, and integration within specialized sarcoma networks.