Background: In advanced nasopharyngeal carcinoma (NPC), biomarkers may help predict survival. Methods: Tumoural expression of ATM, THMS, and RRM1 was correlated with survival in patients with non-metastatic NPC using quantitative fluorescence immunohistochemistry with automated quantitative digital image analysis. Results: Of the 146 patients included, 58 (40%) patients received concurrent chemoradiation therapy; the remainder were treated with radiation. Overall survival (OS) at 5 years was 71% (95% CI 62%-78%); disease-free survival (DFS), 48% (95% CI 39%-57%). OS worsened for increasing values of ATM (HR=2.83; 95% CI 1.01-7.94, p=0.049) for values > 75(th) percentile compared to < 25(th) percentile, but improved for tumours with higher THMS levels (HR=0.44; 95% CI 0.20-0.94, p=0.033) for values > 25(th) percentile compared to ≤ 25(th) percentile. RRM1 was not associated with OS (p=0.748). No biomarkers were associated with DFS. Conclusions: In our cohort, relative overexpression of ATM and low THMS levels were associated with worse overall survival. This article is protected by copyright. All rights reserved.