The Burden and Trends of Soft Tissue and Extraosseous Sarcomas in China: An Observational Study From 1990 to 2021

Background

Soft tissue and extraosseous sarcomas (STS) are rare malignancies of mesenchymal origin characterized by heterogeneous biological behavior, posing substantial diagnostic and therapeutic challenges. In China, the paucity of epidemiological data coupled with disparities in healthcare access has contributed to poorer prognoses, positioning STS as a critical public health concern. This study aimed to comprehensively analyze the epidemiological trends of STS in China over the past three decades and project its future burden, thereby providing evidence-based insights for public health strategies and clinical decision-making.

Methods

This study used data from the Global Burden of Disease 2021 database to evaluate national trends in STS incidence, prevalence, mortality, and burden in China from 1990 to 2021. Statistical analyses included Joinpoint regression to identify temporal inflection points, age-period-cohort modeling to assess age and cohort effects, decomposition analysis to quantify demographic contributors to disease trends, and Bayesian age-period-cohort models to project incidence and mortality through 2036.

Results

From 1990 to 2021, the absolute number of STS cases in China increased, whereas age-standardized incidence rates exhibited a modest decline. While overall prevalence rose substantially in absolute terms, age-standardized prevalence rates decreased by five percentage points. Disability-adjusted life years attributable to STS declined by 18.13%. Significant age- and gender-related disparities were observed, with individuals aged > 75 years experiencing the largest increases in both prevalence and mortality. Men consistently demonstrated higher incidence and mortality rates than women. Age-period-cohort models revealed that adults aged 36–60 years exhibited the most dynamic changes in incidence, with average annual increases ranging from 0.8% to 1.5%. Although overall mortality decreased, individuals born before 1960 contributed disproportionately to the disease burden. Projections for 2036 estimate age-standardized incidence rates of 0.107 and 0.108 per 100,000 for men and women, respectively, with corresponding increases anticipated in mortality rates.

Conclusion

Although the overall burden of STS in China has declined, pre-1960 birth cohorts remain at elevated risk. Population aging is expected to drive continued increases in both morbidity and mortality over the next 15 years, exacerbating long-term care challenges, particularly among middle-aged and elderly individuals. These findings underscore the urgent need for detection strategies, standardized postoperative management, and targeted demographically tailored interventions to mitigate STS burden in resource-limited settings.