{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T14:06:30Z","timestamp":1789221990555,"version":"build-2803163510"},"reference-count":13,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Orthop Surg (Hong Kong)"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the reliability and calibration of the Personalised Sarcoma Care (PERSARC) scoring system in predicting overall survival (OS) for Malaysian patients with high-grade soft tissue sarcoma (STS) of the extremities, and to determine whether PERSARC can effectively stratify patients into risk groups to guide treatment decisions in a Malaysian clinical setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study at a tertiary sarcoma treatment centre in Malaysia, including 115 patients with primary high-grade extremity STS treated between January 2002 and December 2019. PERSARC-predicted 5-year overall survival was compared with observed survival. In accordance with TRIPOD recommendations for external validation, model performance was assessed using discrimination (Harrell\u2019s C-index with bootstrapped confidence intervals and time-dependent area under the curve at 3, 5 and 10 years) and calibration (calibration plot of predicted versus Kaplan-Meier observed survival by quartile of predicted risk, calibration slope, observed-to-expected ratio, and Brier score). A secondary exploratory analysis examined prognostic factors for overall survival using Cox proportional hazards regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a median follow-up of 7.0 years, 42 of 115 patients (36.5%) died. PERSARC showed good discrimination, with a Harrell\u2019s C-index of 0.80 (95% CI 0.73-0.86) and time-dependent AUCs of 0.80, 0.84 and 0.78 at 3, 5 and 10 years, respectively. Risk stratification was clear, with observed 5-year overall survival of 40.0% in the group predicted to have less than 50% 5-year survival, versus 88.8% in the group predicted to exceed it (log-rank p &lt; 0.001). Calibration, however, was imperfect: PERSARC systematically underestimated observed survival across the entire range of predicted risk (observed-to-expected ratio 1.12; calibration slope 0.78, 95% CI 0.53-1.03), with the largest discrepancy in the poorest-prognosis quartile (predicted 22.4% versus observed 37.9%). In the secondary analysis, age, tumour size and distant metastasis were independently associated with mortality, with distant metastasis carrying the greatest hazard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this single-centre Malaysian cohort, PERSARC effectively discriminated between high- and low-risk patients with high-grade extremity STS, supporting its potential value as a structured aid to multidisciplinary discussion and shared decision-making. Calibration was less satisfactory, with consistent underestimation of survival. Therefore, absolute PERSARC-derived survival probabilities should be interpreted with caution in this population. Given the retrospective, single-centre design and modest sample size, these findings should be regarded as preliminary evidence supporting the applicability of PERSARC in Malaysian patients, pending larger multicentre validation and local recalibration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10225536261490152","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:59:57Z","timestamp":1789052397000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Validation of the PERSARC scoring system for overall survival in Malaysian patients with soft tissue sarcoma: A retrospective cohort study"],"prefix":"10.1177","volume":"34","author":[{"given":"Tan","family":"Yuet Yang","sequence":"first","affiliation":[{"name":"National Orthopaedic Centre of Excellence in Research & Learning (NOCERAL)"},{"name":"University Malaya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8899-9266","authenticated-orcid":false,"given":"Vivek","family":"Ajit Singh","sequence":"additional","affiliation":[{"name":"National Orthopaedic Centre of Excellence in Research & Learning (NOCERAL)"},{"name":"University Malaya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6524-8451","authenticated-orcid":false,"given":"Nor Faissal","family":"Yasin","sequence":"additional","affiliation":[{"name":"National Orthopaedic Centre of Excellence in Research & Learning (NOCERAL)"},{"name":"University Malaya"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2016.09.2109"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0959-8049(03)00369-1"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20778"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3182367aa7"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181cf87fa"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2017.06.032"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(16)00010-3"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2018.12.009"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41416-024-02674-y"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.20.3.791"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2018.09.003"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-022-01694-7"},{"issue":"1","key":"e_1_3_6_14_2","first-page":"67","article-title":"Soft tissue sarcoma of extremities: descriptive epidemiological analysis according to national population-based study","volume":"10","author":"Ebrahimpour A","year":"2022","unstructured":"Ebrahimpour A, Chehrassan M, Sadighi M, et al. Soft tissue sarcoma of extremities: descriptive epidemiological analysis according to national population-based study. 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