Abstract
<title>Abstract</title> <p>Background Although surgery is effective for early-stage and recurrent nasopharyngeal carcinoma (NPC), its role in newly diagnosed, locally advanced NPC remains unclear. This study investigates the role of surgery in newly diagnosed nasopharyngeal carcinoma (NPC) patients, comparing survival outcomes between those receiving surgery before chemoradiotherapy (CRT) and those undergoing CRT alone. Methods We analyzed 287 patients from Xiangya Hospital (2009–2020) and 994 from the SEER database (2010–2015). Patients were grouped into Surgery + CRT and CRT cohorts. Propensity score matching (PSM), log-rank tests, and Cox proportional hazards models assessed surgery's impact on survival. Results At our institution, PSM analysis showed no significant differences in 5-year local recurrence-free survival (71.3% vs. 83.9%; P = 0.17), distant disease-free survival (63.5% vs. 81.6%; P = 0.36), progression-free survival (64.1% vs. 80.4%; P = 0.41), or overall survival (OS) (70.6% vs. 85.1%; P = 0.12) between Surgery + CRT and CRT groups. The SEER database also reported similar 5-year OS rates (68.6% vs. 70.0%; P = 0.97). Univariate and multivariate analyses confirmed no significant survival benefits across subgroups. Importantly, long-term adverse effects (AEs) of radiotherapy were comparable between cohorts (P = 0.45). Conclusion Our findings, supported by both institutional and SEER data, indicate that adding surgery to conventional CRT does not significantly improve survival rates for newly diagnosed NPC patients, including specific subgroups. Furthermore, long-term radiotherapy-associated AEs were not increased with surgical intervention.</p>