Objectives: The incidence of soft tissue sarcomas (STS) among older patients is increasing. Although surgical treatment of elderly patients with STS has been reported to improve their prognosis, most of these studies included patients with STS aged &amp;lt; 85 years. This study aimed to analyze the clinical features and prognostic factors of STS in elderly patients aged ≥ 90 years. Subject and Methods: We retrospectively identified patients aged ≥ 90 years with STS who were treated at our two hospitals between 1994 and 2022. Data on clinical information and detailed assessments were collected. We evaluated the features and factors affecting the prognosis of patients with older-extremity STS. In addition, we compared the clinical courses and results of patients treated with surgery and radiotherapy for primary tumors. Results: Among 454 patients with STS, 16 were aged ≥ 90 years. Kaplan–Meier curves for overall survival showed a significantly poorer prognosis in patients who did not receive surgical treatment (p = 0.0348) and those who received radiotherapy (p = 0.0070). Moreover, we investigated the difference in prognosis between surgical treatment and radiotherapy, excluding two cases with distant metastasis at initial diagnosis and one case with no treatment. Kaplan–Meier curves for overall survival showed a significantly better prognosis in patients who underwent surgical treatment (p = 0.0161). Univariate analysis revealed that only primary tumor size was a significant predictor of poor prognosis (p = 0.0426). Conclusion: In patients with STS aged ≥ 90 years old, aggressive surgical treatment may improve the prognosis more than radiotherapy.

The Prognostic Significance of Surgical Treatment for Excessive Elderly Soft Tissue Sarcoma Patients Over 90 Years Old: A Clinicopathological Study of 16 Cases