Defining biochemical, pathological and molecular factors prognostic in terms of disease control and survival in high-grade extremity soft tissue sarcoma: a scoping review

AIMS: High-grade extremity soft tissue sarcomas (eSTS) are rare, heterogeneous malignancies with a high metastatic potential. Prognostic assessment remains challenging due to wide variation in outcomes. Current risk stratification relies on traditional risk factors like age, histology, grade and tumour size, which are embedded in risk classification scores. Recent advances in the fields of biochemistry, pathology and molecular genetics may offer additional prognostic insights, although their clinical utility remains unclear. This scoping review aimed to map the evidence on clinically available biomarkers with potential prognostic value in adults with high-grade eSTS. METHODS: A broad search of MEDLINE and Embase identified 9739 records, of which 74 studies met the eligibility criteria. RESULTS: Overall, available evidence is retrospective and heterogeneous. Potential biomarkers were identified across three domains: biochemical, pathological and molecular. Although several biomarkers showed potential prognostic value, few studies assessed their independence from key confounders. CONCLUSIONS: Standardised validation, with adjustment for established prognostic variables, is needed before these biomarkers can be integrated into risk prediction models for routine clinical practice.