Histopathologic Patterns and Long-Term Survival of Sarcoma in Northern Iran: A 24-Year Retrospective Single-Center Study

Danial Fazilat-panah; Seyed Reza Najafi; Hoda Shirafkan; Masoumeh Karimi; Nima Noori; Shabnam Ashofteh; Ghazaleh Tahernezhad

doi:10.31557/APJCC.2026.11.6.813

Authors

Danial Fazilat-panah Assistant Professor of Radiation Oncology, Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0000-0003-4194-6575
Seyed Reza Najafi Bachelor’s Degree in Radiotherapy, Student Research Committee, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0009-0000-0287-7023
Hoda Shirafkan Associate Professor of Biostatistics, Traditional Medicine and History of Medical Sciences Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0000-0002-5682-1153
Masoumeh Karimi Assistant Professor of Radiation Oncology, Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0000-0003-3968-3438
Nima Noori Bachelor’s Degree in Radiotherapy, Student Research Committee, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0009-0006-9592-4004
Shabnam Ashofteh Residency of Radiation Oncology, Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol I.R. Iran. https://orcid.org/0009-0009-8311-4006
Ghazaleh Tahernezhad Student Research Committee, Babol University of Medical Sciences, Babol, I.R. Iran. https://orcid.org/0009-0005-7406-436X

DOI:

https://doi.org/10.31557/APJCC.2026.11.6.813

Keywords:

Soft-Tissue Sarcoma, Bone Sarcoma, Survival Outcomes, Histologic Pattern

Abstract

Introduction: Sarcomas are rare, heterogeneous malignancies with variable survival outcomes, and long-term regional data from Iran remain limited. This study evaluated histopathologic patterns and long-term survival of sarcoma patients treated at a major referral center in northern Iran over 24 years.

Materials and Methods: In this retrospective cohort study, all patients diagnosed with primary sarcoma at Shahid Rajaei Radiotherapy Center (Babolsar) between 2001 and 2024 were reviewed. Demographic and histopathological data were extracted, and overall survival (OS) was assessed at 1-, 2-, and 5-year intervals using Kaplan–Meier analysis and Log-rank tests. Cox proportional hazards regression was applied to examine associations between demographic and histopathologic variables and overall mortality.

Results: A total of 278 eligible patients were included (51.1% male; mean age: 48.2±18.1 years). Soft tissue sarcomas (STS) predominated (91.7%), while Bone tissue sarcomas (BTS) accounted for 8.3% of cases and occurred at significantly younger ages (p<0.001). Liposarcoma (14.7%), leiomyosarcoma (12.6%), synovial sarcoma (11.9%), and malignant fibrous histiocytoma (MFH) (11.9%) were the most common STS subtypes. The overall survival was 49.3%, with 1-, 2-, and 5-year survival of 82.7%, 71.2%, and 56.5%, respectively. Median OS was longer in STS than BTS (62 vs. 43 months), although not statistically significant (Log-rank p=0.273). Subgroup analysis revealed significant survival differences among STS subtypes compared with BTS (p=0.016). In Cox analysis, age was consistently associated with increased mortality across all intervals (overall HR=1.042 per year; p<0.001). Leiomyosarcoma (HR=2.991; p=0.018) and the “Other STS” group (HR=2.741; p=0.028) showed higher overall mortality risk in unadjusted Cox analysis, whereas liposarcoma, synovial sarcoma, and MFH demonstrated protective effects in selected time intervals.

Conclusion: This study highlights the predominance and histopathological heterogeneity of soft tissue sarcomas and describes survival patterns across age groups and histologic subtypes in a long-term, single-center cohort. However, the lack of data on tumor grade, stage, surgical margins, and treatment limits independent prognostic interpretation. Multicenter studies incorporating treatment details and molecular profiling are essential to improve descriptive risk characterization and future stratification frameworks.