OBJECTIVE
To characterize overall survival (OS) and prognostic factors in sarcomas of the forearm and hand after exclusion of carcinoma and other non-sarcoma diagnoses and to explore OS according to index surgical strategy.
METHODS
This multicenter retrospective cohort included 59 unique patients with histologically defined forearm and hand sarcoma treated at four tertiary referral centers between November 2008 and March 2025. Overall survival was analyzed using Kaplan-Meier and log-rank methods. Univariable Cox models evaluated baseline prognostic factors. A parsimonious age-adjusted Cox model assessed baseline regional nodal and/or distant metastatic disease, with Firth-penalized Cox regression performed as a sparse-event sensitivity analysis.
RESULTS
Median age was 48 years; 53 patients had soft-tissue sarcoma and 6 had bone sarcoma. Eleven deaths occurred. Estimated OS was 92.7% at 1 year and 74.8% at both 3 and 5 years. Baseline regional nodal and/or distant metastatic disease was present in 6 of 53 classifiable patients (3 regional nodal only and 3 distant pulmonary metastases) and was associated with poorer OS (5-year OS, 44.4% vs 84.1%; log-rank p=0.024). In the conventional age-adjusted Cox model, the association persisted (HR, 6.85; 95% CI, 1.31-35.79; p=0.023), with a similar Firth-penalized estimate (HR, 7.36; 95% profile-likelihood CI, 1.41-34.58; p=0.020). OS did not differ by limb-sparing surgery versus amputation (p=0.904).
CONCLUSION
Baseline regional nodal and/or distant metastatic disease was associated with substantially poorer OS. Limb-sparing surgery was the predominant definitive strategy. Because outcome events were sparse and treatment selection was retrospective, adjusted and surgical comparisons should be interpreted cautiously.
Keywords: Limb Salvage; metastasis; prognosis; sarcoma; survival analysis; upper extremity.
, Hüseyin Bilgehan ÇEVİK1 
