OBJECTIVE: To analyze nuclear factor-kappa B inhibitor alpha (IκBα) expression in hepatocellular carcinoma (HCC) tumors and adjacent normal tissues and to examine how this expression relates to the clinicopathological features and prognoses of HCC patients. STUDY DESIGN: This study included 78 HCC patients who underwent surgical treatment at our hospital between May 2002 and May 2008. In those 78 cases, samples of normal liver tissue adjacent to tumors were collected as controls. Complete clinical data were available for all patients, and the follow-up period was 5 years. IκBα protein expression was detected by immunohistochemistry. RESULTS: Positive staining for the IκBα protein occurred at a significantly lower rate in HCC tissue than in adjacent normal tissue (21.8% vs. 91.1%). Further analysis revealed that the rate of positive IκBα staining was not significantly associated with age, gender, pathological grade, TNM stage, or serum alphafetoprotein level (p > 0.05 for all analyses). However, in the context of HCC, IκBα expression was significantly associated with clinical stage and tumor size (p < 0.05 for both analyses). In addition, the 5-year survival rate was significantly higher for IκBα-positive patients than for IκBα-negative patients (p < 0.05). CONCLUSION: IκBα expression is significantly reduced in HCC tissue and is closely related to the prognoses of HCC patients. © Science Printers and Publishers, Inc.