To investigate the expression of extracellular matrix protein 1 (ECM1) in benign laryngeal lesions, precancerous lesions and malignant laryngeal lesions and analyze the clinical significance of ECM1 changes in the pathogenesis and metastasis of laryngeal carcinoma.A total of 46 patients with laryngeal lesions were recruited with a median age of 48.2 years (range: 33-67 years). Among these patients, 29 had laryngeal carcinoma (12 with metastasis and 17 without metastasis), 8 had benign laryngeal lesions and 9 had precancerous laryngeal lesions (laryngeal leukoplakia). Immunofluorescence staining was employed to detect the protein expression of ECM1 in benign laryngeal lesions, laryngeal leukoplakia and malignant laryngeal lesions; RT-PCR was used to measure the mRNA expression of ECM1 in laryngeal carcinoma and benign laryngeal lesions.ECM1 expression was detected in 25% (2/8) of patients with benign laryngeal lesions, 78% (7/9) of patients with precancerous laryngeal lesions, and 100% (29/29) of patients with laryngeal carcinoma. Among the laryngeal carcinoma patients, high ECM1 expression (+++) was found in 64.7% (11/17) of patients without lymph node metastasis and 91.7% (11/12) of patients with lymph node metastasis. Increased ECM1 expression was found in laryngeal carcinoma when compared with other laryngeal lesions and the ECM1 expression in patients with metastasis was significantly higher than that patients without metastasis (P<0.01). RT-PCR showed that the mRNA expression of ECM-1 in laryngeal carcinoma was markedly higher than that in benign laryngeal lesions.ECM1 expression is in an increasing order in benign laryngeal lesions, precancerous laryngeal lesions and malignant laryngeal lesions. Meanwhile, the metastatic laryngeal carcinoma has higher ECM1 expression than laryngeal carcinoma without metastasis. Our findings suggest that ECM1 plays promotive roles in the occurrence, development and metastasis of laryngeal carcinoma.