It is vital to identify the optimal treatment of sarcomas in AYA patients. However, there is still little evidence, and protocols on how to treat sarcomas in AYA patients have not been clarified in detail. In the current study, we reviewed sarcoma patients treated surgically in our hospital and analyzed which types of patients had poor outcomes. Patients with late-stage sarcomas, inadequate tumor margin, or a high ASA-PS score had a poor prognosis.
The 5-year survival rate in AYA sarcoma patients is approximately 70% [10, 17], although prognoses in AYA patients may vary depending on age . Our previous study showed that the 5-year survival rate of elderly sarcoma patients was 86% . In the current study, the 3-year survival rate was poorer (61.36%) than those previously reported  and that of elderly patients in our hospital. There was also no significant difference in survival rates based on age among these AYA patients. These findings suggest that the AYA generation itself may be a poor prognostic factor.
In general, high-grade sarcoma has a poorer prognosis than low-grade sarcoma . Aggressive high-grade malignancies often arise in AYAs . Additionally, late-stage sarcomas have a poorer prognosis than early-stage sarcomas . Approximately 80% of AYA sarcoma patients are diagnosed at an early stage . In the current study, we found that AYA sarcoma patients with late-stage sarcomas had a poorer prognosis than those with early-stage sarcomas. These findings suggest that early diagnosis is necessary to obtain a favorable outcome for AYA sarcoma patients.
A Canadian registry showed that the mean operation time for sarcoma was 4 hours, and an operation time > 5 hours increased the likelihood of reoperation because of wound complications, such as infection . In elderly sarcoma patients, the mean operation time is 114.7 minutes and the mean blood loss is 160.7 mL . Additionally, a previous study showed that the infection rate after surgical treatment for sarcomas was 23.3% . In the current study, there was no reoperation and no patients developed infection; however, the operation time and intraoperative blood loss were longer and larger, respectively, than those previously reported for elderly sarcoma patients .
Achieving a wide margin is important to obtain favorable outcomes [18, 25, 26]. In the current study, all patients with inadequate margins after surgical treatment experienced recurrence. These findings suggest that achieving an adequate surgical margin is important in the surgical management of AYA sarcoma patients to obtain a favorable prognosis.
The ASA-PS is a general condition classification by the American Society of Anesthesiologists . Recently, Iwai et al. reported that the prognosis of elderly sarcoma patients is correlated with ASA-PS before surgery . In the current study, all patients with an ASA-PS ≥ 2 died. These findings suggest that the ASA-PS may also influence the prognosis or outcome of AYA sarcoma patients undergoing surgical treatment.