Soft tissue sarcomas (STS) are rare, heterogeneous mesenchymal malignancies with variable clinical behavior and prognosis. Identifying prognostic factors is crucial for informing treatment strategies and enhancing patient outcomes.

This retrospective, single-center cohort study reviewed the medical records of 223 patients diagnosed with STS between November 2002 and January 2014. Demographic, clinical, pathological, and treatment-related variables were also recorded. Recurrence, metastasis, and survival outcomes were analyzed using Kaplan–Meier curves and Cox proportional hazard models.

Of the 223 patients, 113 (50.7%) were women, and the median age was 47 years. The most common tumor site was the extremity (39.9%). Curative surgery was performed in 63.2% of cases, and a positive surgical margin was observed in 23.8% of cases. Among the 138 patients with evaluable follow-up, recurrence or progression occurred in 68.8% of patients. Patients with tumors > 10 cm had a significantly higher risk of recurrence (HR: 2.705, 95% CI: 1.371–5.341; p = 0.004) and mortality (HR: 3.946, 95% CI: 1.361–11.444; p = 0.011). Grade 3 histology was associated with a four-fold increase in mortality risk (HR: 4.180; p = 0.013). Lymph node positivity and Stage IV disease were also independent predictors of poor outcomes. Progression-free and overall survival were significantly shorter in patients with advanced-stage, high-grade tumors, and positive margins.

Tumor size, grade, lymph node status, recurrence history, and stage at diagnosis are key prognostic factors for STS survival in this cohort. These variables should be integrated into individualized risk-based treatment and follow-up strategies.