In this study, a clinical prediction model was constructed by the SEER database to predict postoperative OS in elderly patients with STS. The nomogram we created, as shown in Fig. 3, can accurately predict OS at 1, 3, and 5 years. This is the first study to use extensive and diverse case data to build a predictive nomogram model for elderly postoperative patients with STS. This prediction nomogram can easily predict patients' prognosis, inform patients of the benefits of certain treatments, and has important implications for clinical decision-making.
It's vital to keep in mind that not all groups of elderly adults with STS can be surgically treated. In the present results, the prognosis of elderly postoperative patients with STS > 82 years of age was worse compared to patients in the 73–82 years age group. It was similarly confirmed in previous single-center institutional studies that age is not a contraindication to surgery in elderly cancer patients with STS[15–17]. Buchner et al. prospectively studied 21 STS patients over the age of 70, and they discovered that even after surgery, these patients had a worse 5-year OS[18]. Lahat et al. analyzed 325 STS ≥ 65 years of age patients were analyzed while selecting appropriate elderly patients among these individuals for surgery. They noted a decrease in bit survival after surgery in patients > 75 years of age. However, postoperative adverse effects and recovery time did not differ significantly between these STS age groups[7]. In another study it was also confirmed that surgery is safe and that reduced surgical use in the elderly may be an area of improved prognosis, while this study also noted a significant reduction in mortality in the elderly at 90 days after undergoing STS, suggesting that the postoperative 90-day period is key to the increased surgical risk affecting elderly patients with STS. Whether these factors influence surgical decision-making in elderly patients directly or indirectly[19]. Taken together, each of these studies concludes that despite the reduced OS in the elderly patient population after surgery compared to the younger patient population, surgery is still advisable for the relatively low perioperative complication rate and postoperative adverse effects in a subset of appropriate elderly patients with STS.
And whether tumors metastasize or not, disease stage and tumor size also have a different prognosis for elderly patients with STS after surgery. Elderly patients with STS who developed distant metastasis in this study had a poorer OS in comparison to elderly patients with localized tumors. And the poorer prognosis after surgery in elderly patients with STS with tumor diameter size > 100 mm is an important disadvantage. Several studies to date have confirmed the prognostic factors associated with the diagnosis of STS in adults. In previous studies, the most common unfavorable prognostic factors for elderly postoperative patients with STS were found to be:1. site of tumor occurrence: including head, neck, and trunk, 2. different subtypes of tumors, 3. deeper tumor location, 4. residual tumor cells are still present at the surgical incision margin, 5. tumor size > 5 cm, and other factors[20–24]. Previous research has indicated that younger STS patients are more likely than older STS patients to develop tumors in a deeper position. Smaller tumor diameter and lower tumor grade were found to be independent risk variables for recurrence-free survival and OS in younger and older STS patients, even though older STS patients had larger tumors and a higher proportion of graded tumors[25]. Therefore, compared with younger patients with STS, older patients have relatively larger tumors, higher tumor stage, and grade, and are prone to distant metastases, causing some surgical difficulty and making surgical decisions difficult, which may also contribute to the poorer prognosis of older patients with STS.
In previous studies, researchers have examined fewer prognostic factors associated with STS in older postoperative patients, making the present study even more valuable. Furthermore, investigating separate risk factors to enhance patient prognosis is less useful than developing a clinical prediction model. The nomogram offers a high level of predictability and can be used as a guide for patient consultation, risk assessment, and clinical decision-making. Despite these benefits, this research has several limitations. First, when we selected the relevant data in the SEER database, the data about chemotherapy modality and radiotherapy means were not detailed, so we could not distinguish which one was used for radiotherapy and chemotherapy. Furthermore, because this is a retrospective analysis, participants with missing clinical or survival data were eliminated. This study has relatively few postoperative cases in the screened SEER database, and further data are needed for external validation. However, this study combined with rigorous statistical analysis through large sample data, several characteristics connected to the OS of elderly postoperative patients with STS were identified, and a predictive nomogram was developed to provide appropriate help for clinical treatment. The predictive model we constructed allows us to identify patients whose prognosis is worrisome, and then give them more attention and more frequent follow-ups. In addition, predictive models can help clinicians to answer patients' prognostic inquiries. However, given the limitations of the SEER database, in the future, we hope to include more detailed patient information (e.g., mode of surgery, chemotherapy regimen, radiation dose, and even genetic information) to continue to refine a more meaningful prediction model with better predictive accuracy.