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944; 95% confidence interval [CI] 2.76-12.8; P .001) and chemoradiotherapy (CRT) (HR = 2.321; 95% CI 1.36-3.97; P = .002) were both associated with decreased 5-year OS compared to a group consisting of all surgeries. When this analysis was repeated for only stage III cases, RT (HR = 1.134; 95% CI 0.38-3.37; P = .821) and CRT (HR = 1.784; 95% CI 0.78-4.08; P = .17 were equivalent to surgery. Using the NCDB to study the largest cohort of SSCC with known staging and treatment, primary surgery may provide a better 5-year OS in advance