Epidemiology of sarcoma in Syria: A retrospective study from the national referral center.

e23504 Background: The Syrian conflict has devastated healthcare infrastructure, creating a critical data gap in cancer epidemiology. This study presents the first analysis of sarcoma from Syria's main oncology center, characterizing patient demographics to establish baseline data for conflict-affected settings. Methods: This is a retrospective study at Al-Bairouni University Hospital – Syria’s national cancer center serving 65-70% of the country’s cancer patients. We included patients > 18 diagnosed with Sarcoma between 1 January 2024 and 31 December 2025. Data extracted from hospital records included sex, age at diagnosis, cancer stage, grade, smoking status, and the governorate of residence. Institutional ethical approval was obtained to perform the study. Results: A total of 500 patients were diagnosed with sarcoma during the study period: 250 in 2024 and 250 in 2025 (Table 1). Across all years, a consistent male predominance was observed 55.5%. The average age at diagnosis was 46.9 years, 35.6% of patients were smokers, 55.5% were high grade and 51% of all cases had advanced/metastatic disease at diagnosis. The highest patient loads originated from Damascus (23.4%) and Rural Damascus (11.6%), followed by central governorates such as Homs and Hama (17.6%). Notably, patients from more distant and underserved governorates such as Deir ez-Zor (7.6%), Aleppo (12.2%), and Al-Hasakeh with Raqqa (9.8%) accounted for a significant proportion of the Sarcoma presenting to our center. Smoking status predicted high-grade histology (OR: 2.34, 95% CI:1.42–3.87, p = 0.008). Patient age was not associated with advanced disease diagnosis (β = 0.03, 95% CI:-0.05–0.11, p = 0.32). Controlling for age and sex, sarcoma subtype independently predicted metastatic presentation (OR:3.15, 95% CI: 1.89–5.24, p < 0.001). Conclusions: Syria's first nationwide sarcoma analysis reveals widespread smoking and late diagnoses as critical challenges, calling for urgent prevention and early detection efforts. This provides essential evidence for health planning in conflict settings. Diagnosis 2024 Cases 2025 Cases Total cases Average Age Male Sex (%) Smokers (%) High grade Advanced/Metastatic at diagnosis Angiomyosarcoma 4 3 7 54.7 28.5% 28.7% 50% 50% Ewing 23 18 41 32.5 75% 43.9% 50% 43% Dermatofibrosarcoma 3 13 16 61.3 56.2% 37% 33.3% 57% fibrosarcoma 18 13 31 38.8 51.6% 32.2% 61.1% 50% giant cell 3 8 11 27.7 63.6% 27.2% 33.3% 43% gist 21 - 21 55.3 68.1% 31.8% 50% 68% Kaposi 6 13 19 67.3 68.4% 36.8% 41% 50% liposarcoma 27 24 52 57.5 57.6% 34.6% 52%