Background Nasopharyngeal carcinoma (NPC) is one of the most common malignancies in southern China. than that of patients with dual low-expression (18.22% vs. 73.54%, respectively; P = 0.0003). Multivariate analysis indicated that both survivin and VEGF over-expression in NPC tumor tissues were strong independent factors of poor prognosis in NPC patients. The mean AI in the 39 survivin low-expression cases was 144.7 39.9, which was significantly higher than that in 61 survivin over-expression cases (111.6 39.8) (T test, P < 0.05). Conclusion Survivin and VEGF over-expression are independent prognostic factors for the patients with NPC. These results also suggest that tumor survivin and VEGF expressions are valuable prognostic markers for prognosis prediction in NPC patients. Introduction Inhibition of apoptosis may be involved in the pathogenesis of cancer by prolonging cell life and facilitating retention of deleterious mutations. Several inhibitors of apoptosis related to the baculovirus inhibitors of apoptosis (IAP) gene have been identified. Among these, a structurally unique member of the IAP proteins, survivin, a Mr~16.500 cytoplasmic protein with a single BIR and no RING finger is unique for its expression in fetal tissue and in a variety of human cancers, but not in non-proliferating adult tissue[2,3]. In addition to IGSF8 its function as an inhibitor of apoptosis, survivin is involved in the regulation of cellular proliferation and angiogenesis in cancer [4,5]. Remarkably, increased survivin expression has been observed in the most common human neoplasm, including oesophageal cancer , ovarian carcinoma, laryngeal squamous cell carcinoma , colorectal carcinoma , breast carcinoma and lymphoma. Most of these studies have demonstrated a positive correlation between survivin expression and poor prognosis of the disease, where a multivariate statistical analysis has revealed that survivin expression is an independent prognostic factor for disease progression[6,10-12]. Angiogenesis is an essential step for tumor growth, playing a critical role in tumor invasion and metastasis. Tumors develop angiogenesis by secreting growth factors, to stimulate endothelial migration and proliferation[14,15]. Among these growth factors, VEGF is regarded as the main growth stimulatory factor in the tumor-related angiogenesis. Human VEGF is located on chromosome 6p21.3 and it plays a critical role in the initial phase of 58479-68-8 manufacture tumor growth and neo-vascularisation. In vitro and in vivo experiments have shown that increased VEGF expression is associated with tumor growth and metastasis, whereas inhibition of 58479-68-8 manufacture VEGF expression results in suppression of tumor growth and tumor-induced angiogenesis . Furthermore, A number of studies in various cancer types have confirmed that VEGF over-expression is closely correlated with the presence of metastasis and recurrence and also with poor survival rate of patients[14,19-22], including NPC. NPC is one of the most common malignancies in certain areas of southern China, South-Asia and North Africa[23, 24] and has a dominant clinicopathological behavior of easily invasive and metastasis, which is different from other head and neck cancers . Metastasis to regional lymph node or distant organ and local recurrence are two major causes for treatment failure of this cancer. Currently, the prediction of NPC prognosis is mainly based on the clinical TNM 58479-68-8 manufacture staging, however, NPC patients with the same clinical stage often present different clinical outcomes, suggesting that this TNM stage is insufficient to precisely predict the prognosis of this disease [26-29]. Therefore, it is important to search for novel molecular biomarkers, which can help clinicians improve the prognostic prediction and develop therapeutic intervention for NPC patients. In this study, we assessed the expression of survivin and VEGF in NPC and their correlations to the clinicopathological parameters and overall survival of the patients. Materials and methods Cases and clinical parameters For this retrospective study, archival formalin-fixed, paraffin-embedded specimens from 280 primary NPC patients during 1992 ~ 2002 in Sun Yat-Sen University Cancer Center (Guangzhou,.