本研究旨在收集癌症导向手术（CDS）对转移性头颈癌（M1 HNC）患者的生存益处的证据，并确定哪些患者会从CDS中获益最多。通过SEER数据库识别M1 HNC患者。根据是否接受CDS，将患者分为CDS组和非CDS组。使用倾向评分匹配（PSM）最小化两组之间的偏差，使用Kaplan-Meier分析，Log-rank检验和Cox比例风险模型研究CDS的预后作用。主要终点是总生存期（OS），次要终点是癌症特异性生存期（CSS）。共提取了3215例M1 HNC患者，其中566例接受了CDS，与未接受CDS的患者进行了1:1的倾向评分匹配。在匹配的数据集中，CDS组的中位OS和CSS较非CDS组显著升高（OS：19.0 vs. 9.0个月，p<0.001；CSS：21.0 vs. 9.0个月，p<0.001）。同时，多变量Cox回归分析也表明CDS是OS和CSS的有利预后因素。此外，M1 HNC患者的亚组（年轻年龄、结婚状态、I-II级别、咽峡部位、早期T/N分期、放疗）更易从CDS中获益，而接受化疗的患者未从CDS中获益。本研究表明，CDS与M1 HNC患者的生存率改善相关，尤其是那些从CDS治疗中获益更多的亚群体。《3 Laryngoscope，2023》。©2023美国喉咙科、鼻科和耳科学会。

This study aimed to gather evidence for the survival benefit of cancer-directed surgery (CDS) in metastatic head and neck cancer (M1 HNC) and identify which patients will benefit most from CDS.Patients with M1 HNC were identified within the SEER database. According to whether received CDS, patients were divided into the CDS and non-CDS groups. The bias between the two groups was minimized using Propensity Score Matching (PSM), and the prognostic role of CDS was investigated using Kaplan-Meier analysis, log-rank test, and Cox proportional hazard models. The primary endpoint was overall survival (OS), and the secondary endpoint was cancer-specific survival (CSS).A total of 3215 patients with M1 HNC were extracted, including 566 patients who received CDS that were 1:1 propensity score-matched with patients who did not receive CDS. In the matched dataset, the median OS and CSS in CDS groups were significantly higher than in non-CDS groups (OS: 19.0 vs. 9.0 months, p < 0.001; CSS: 21.0 vs. 9.0 months, p < 0.001). Meanwhile, multivariable Cox regression analysis also revealed that CDS was a favorable prognostic factor for both OS and CSS. Furthermore, subgroups of patients with M1 HNC (younger age, being married, grade I-II, oropharynx site, earlier T/N stage, radiotherapy) were inclined to benefit from CDS, while those patients who received chemotherapy failed to benefit from CDS.This study indicated that CDS was associated with improved survival in M1 HNC, especially for those subpopulations that benefit more from CDS treatment.3 Laryngoscope, 2023.© 2023 The American Laryngological, Rhinological and Otological Society, Inc.