Abstract
OBJECTIVE: Japan is one of the most rapidly aging societies worldwide, and the incidence of rare malignancies such as sarcoma is expected to rise among the very elderly. Chronological age often influences treatment decisions, but such bias may deprive patients of optimal management. Clarifying treatment outcome and prognostic factors in this population is essential for evidence-based treatment strategies. PATIENTS AND METHODS: We analyzed 21 patients aged 85 years or older who were diagnosed with sarcoma at our institution. Clinical characteristics, treatment modalities, and outcomes were reviewed. Univariate analyses were performed for categorical variables. Overall survival was estimated with the Kaplan–Meier method. RESULTS: The mean age of the cohort was 87.6 years, and 20 patients (95.2%) underwent surgical resection. Radiotherapy was administered in 6 cases (30%), whereas no patients received chemotherapy. At the last follow-up, 15 patients were alive without disease, 2 were alive with disease, 3 had died of disease, and 1 had died of non–cancer-related causes. No statistically significant associations were identified, probably due to the limited sample size. CONCLUSION: Surgical resection is feasible and can provide long-term benefit in selected patients aged 85 years or older with sarcoma. Analyses focusing on super-elderly patients indicated that refraining from surgery solely due to advanced age could potentially deprive patients of the benefits they may otherwise obtain. Thus, while age remains an important risk factor for surgical complications, individual decisions to perform tumor resection should be made with careful consideration of each patient’s overall condition. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12957-026-04286-7.