Objective To explore the correlation between serum lipid levels and clinical characteristics and survival prognosis of patients with middle- to late-stage nasopharyngeal carcinoma NPC . Method To retrospectively analyze 285 patients with NPC stage Ⅲ-Ⅳ in Affiliated Hospital of Jiangnan University and collect serum lipid-related indexes of high-density lipoprotein cholesterol HDL-C low-density lipoprotein cholesterol LDL-C apolipoprotein A1 ApoA1 apolipoprotein B ApoB apolipoprotein E ApoE cholesterol CHOL and triglyceride TG . Statistical analysis and clinical prognostic evaluation were performed using univariate and multivariate Cox regression Kaplan-Meier survival curves and ROC curves. Result ApoA1 was significantly higher in NPC patients aged ≥55 years than in NPC patients aged <55 years P= 0. 013 . Further grouped by gender the results showed that HDL-C was significantly higher in the female group than in the male group P= 0. 001 . The results of Cox one-way analysis showed that the difference in OS between high CHOL level and NPC patients was statistically significant HR = 1. 626 95% CI = 1. 065 - 2. 482 P= 0. 024 . Further ApoB ApoE and CHOL with P<0. 1 were included in a multifactorial Cox proportional risk analysis which showed that CHOL was a risk factor for NPC prognosis HR = 1. 613 95% CI = 1. 058-2. 460 P = 0. 026 . The differences in HDL-C P= 0. 024 LDL-C P = 0. 001 and ApoB P = 0. 001 were statistically significant at different baseline CHOL levels. Survival time was longer in the low CHOL group than in the high CHOL group and the low CHOL group had a higher overall survival time P= 0. 025 . ROC curve analysis showed that the area under the curve of CHOL predicting NPC prognosis AUC = 0. 581 95% CI = 0. 505-0. 656 P= 0. 037 . Conclusion Significant differences in serum lipids were found between the different clinical features of patients with middle and advanced NPC Serum CHOL emerged as an independent predictor of prognosis in patients with middle and advanced NPC and High cholesterol level is a risk factor for nasopharyngeal carcinoma patients and is associated with poor prognosis.