Conclusion

Surgical resection, particularly when combined with chemotherapy, was associated with higher survival among patients with primary cardiac malignancies, whereas radiotherapy showed limited association with survival and was primarily related to other cancer-related outcomes. Younger patients with regional or distant disease showed stronger associations between surgical or multimodal approaches and survival, while these associations were attenuated among older adults. These findings underscore the importance of individualized, age-adapted treatment strategies to optimize outcomes in this rare and aggressive cancer.