Abstract: Objective To investigate the expression and clinical significance of long chain non-coding RNA ZFAS1 in nasopharyngeal carcinoma. Methods A total of 94 specimens of nasopharyngeal carcinoma and paired noncancerous tissues were collected from January 2014 to December 2016. The expression of ZFAS1 in cancer tissues and noncancerous tissues was detected by real-time quantitative polymerase chain reaction（QPCR）. The relationship between the expression of ZFAS1 and the clinicopathological features of nasopharyngeal carcinoma（age，T staging，N staging，TNM staging，skull base invasion，cranial nerve palsy and EB virus VCA-IgA level） was analyzed. The receiver operating characteristic curve（ROC）was used to evaluate the effectiveness of tissue ZFAS1 levels in the early diagnosis of nasopharyngeal carcinoma. Results The expression level of ZFAS1 in 94 cases of nasopharyngeal carcinomas was 5.388±0.446 with the median and four percentile interval of 3.933（2.107，7.339），in noncanerous tissues was 1.091±0.045 with the median and four percentile interval of 1.092（0.799，1.297）. The ZFAS1 level was higher in nasopharyngeal carcinoma tissues than in noncanerous tissues，and the difference was statistically significant（P＜0.05）. The expression of ZFAS1 was related to T staging，TNM staging，EB virus VCA-IgA level and skull base invasion（P＜0.05）in nasopharyngeal carcinoma tissues. It was not related to cranial nerve palsy and age（P＞0.05）. The area under the curve of ZFAS1 in the diagnosis of nasopharyngeal carcinoma was 0.924（95％CI：0.882-0.965），and the optimal cut-off value was 3.472，and the sensitivity and specificity of the cut-off value were 83.4％ and 77.0％，respectively. Conclusion ZFAS1 is highly expressed in nasopharyngeal carcinoma and is related to clinical staging，invasion of skull base and EB virus infection. It has good value in the early diagnosis of nasopharyngeal carcinoma and can be used for the diagnosis and evaluation of nasopharyngeal carcinoma.