Background: Current guidelines lack definitive evidences about the relative benefits of locoregional surgery for the primary tumor in de novo stage IV breast cancer. The aim of this study was to comprehensively investigate the role of locoregional surgery for primary tumor in de novo stage IV breast cancer. Methods: We conducted a Chinese multicenter real-world study of patient-level data to investigate the effect of locoregional surgery versus no surgery of the primary tumor in de novo stage IV breast cancer. We used propensity score matching to compare similar patients who underwent locoregional surgery and no surgery. Overall survival (OS) was estimated using the Kaplan-Meier method and the log-rank test. A meta-analysis also was performed of prospective and retrospective studies, respectively. Results: Among 353 patients, 189 (53.6%) received locoregional surgery and 164 (46.4%) underwent no surgery. We matched 202 patients treated with locoregional surgery with similar patients who received no surgery. The median follow-up time was 22.1 (95%CI, 18.8 to 25.9) months, 5-year overall survival was 62.4% in the locoregional surgery group versus 60.3% in the no surgery group, and there was no significant difference in OS (Hazard ratio [HR] 0.88, 95%CI 0.49 to 1.57, P = 0.66). In stratified analysis, the association between locoregional surgery and improved survival was particularly marked in patients with Ki67 ≥ 20% (HR 0.47, 95%CI 0.22 to 0.97). In addition, pooled results from 42 retrospective studies with 130,153 individuals indicated that locoregional surgery resulted into a significantly prolonged OS (HR 0.65, 95% CI 0.61 to 0.69) compared with no surgery. In contrast, we analyzed the meta-analysis from five prospective trials with 857 participants, finding that there was no significant difference in OS (HR 0.84, 95% CI 0.61 to 1.15) between two groups. Conclusions: Based on the evidences of our real-world study, prospective and retrospective meta-analysis, we concluded that locoregional surgery of the primary tumor have no significant survival benefit in de novo stage IV breast cancer. Patients with Ki67 ≥ 20% improved survival while receiving locoregional surgery.