Primary tumor resection in de novo metastatic tongue squamous cell carcinoma: a real-world study

The therapeutic value of primary tumor resection (PTR) in the management of de novo metastatic tongue squamous cell carcinoma (mTSCC) remains unclear. This study sought to evaluate the effect of PTR on overall survival (OS) in patients with de novo mTSCC within a real-world, population-based cohort. Patients diagnosed with mTSCC were identified from the Surveillance, Epidemiology, and End Results database (2010-2022). Survival outcomes between surgical and non-surgical groups were compared using Kaplan-Meier analysis and log-rank tests. Propensity score matching (PSM) and multivariable Cox proportional hazards models were used to adjust for confounding variables and to identify independent prognostic factors, respectively. Of 903 de novo mTSCC patients, 83 (9.2%) underwent PTR. The lung was the predominant site of solitary metastasis (54.5%). In the entire cohort, PTR was not significantly associated with improved OS (median OS: 9.0 vs. 8.0 months, P = 0.35), a finding that remained consistent after PSM. No survival benefit attributable to surgery was observed within any specific metastatic pattern, including lung-only, bone-only, liver-only, or multi-organ metastases. Within the surgical cohort, multivariable analysis identified advanced age(> 70 years), unmarried status, and advanced nodal involvement (N2/N3) as independent predictors of poorer OS, while the combination of surgery with radiotherapy emerged as an independent favorable prognostic factor. In this real‑world cohort, PTR was not significantly associated with improved overall survival in the general population of mTSCC patients. However, this finding does not preclude potential benefit in some selected subgroups, such as those with symptomatic improvement, oligometastases, or low‑grade disease. PTR did not confer a survival advantage in the overall mTSCC patients, underscoring the need for rigorous, biomarker-driven patient selection.