Background <p>Breast cancer is the most common malignancy among women, with triple-negative breast cancer associated with the poorest prognosis, often metastasizing to the bones. There is still controversy over whether surgical resection of the primary site can provide survival benefits in patients with TNBC bone metastases only. We conducted a retrospective analysis of this issue using the SEER database.</p> Methods <p>435 TNBC patients with bone metastasis at the time of diagnosis were extracted from the population-based Surveillance, Epidemiology, and End Results database (SEER). The bias between surgery and non-surgery group was minimized with Propensity Score Matching (PSM).</p> Results <p>There were 126 patients in each group after PSM. Univariate and multivariate analysis showed that histology type, chemotherapy and surgery were significant prognostic indicators. Stepwise regression analysis also yielded the same results. Compared with the non-surgery group, primary site surgery group has longer OS and CSS. Subgroup analysis shows that expanding the surgical scope does not have significant prognostic benefits for both OS and CSS. Further analysis showed that surgery plus systemic treatment is a better option than only surgery.</p> Conclusion <p>In TNBC patients with bone metastases only, compared to the non-surgery group, the primary site surgery group shows longer OS and CSS. Surgery combined with systemic treatment is a preferable treatment option.</p>