Abstract
<title>Abstract</title> <p>Background Chondrosarcomas are the second most common primary malignant cartilage tumors of the skeletal system. While they typically manifest in the pelvis and proximal long bones, atypical localizations—such as the hands, feet, and distal radius—account for less than 10% of all cases. Due to anatomical constraints in these regions, they present unique diagnostic and surgical challenges. The impact of parameters like tumor size and soft tissue extension on oncological survival remains highly debated. This study aims to evaluate the critical parameters affecting prognosis, the significance of surgical margins, and long-term oncological outcomes in a rare series of 20 atypical localization chondrosarcomas. Methods A retrospective review was conducted on 20 patients (13 males, 7 females; mean age 49.3 years) diagnosed with atypical localization chondrosarcoma between 2014 and 2024. Patients with classic chondrosarcomas located in the pelvis or proximal long bones (femur, humerus), those with less than 1 year of follow-up, and patients unwilling to participate were excluded from the study. Demographic details, tumor characteristics, histopathological data, and surgical treatments were analyzed. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score and the Visual Analog Scale (VAS) for pain. Oncological outcomes were evaluated via Kaplan-Meier survival analysis and Receiver Operating Characteristic (ROC) curve analysis. Results The mean follow-up period was 44.2 months, and the 5-year overall survival (OS) rate was 90%. Histological grade emerged as the strongest predictor of survival (p = 0.001). Soft tissue involvement significantly reduced the 5-year disease-free survival (DFS) from 91.2% to 51.4% (p = 0.034). Postoperative functional status was highly satisfactory, with a mean MSTS score of 24.2 out of 30. Conclusion Atypical localization chondrosarcomas are rare entities that can be easily overlooked due to their unusual presentation sites. While soft tissue extension is a critical determining factor for local control, tumor size serves as a significant warning indicator for systemic dissemination.</p>