We evaluated the clinical significance of indoleamine 2,3-dioxygenase (IDO) in esophageal squamous cell carcinomas. Operative specimens obtained from 30 patients with esophageal squamous cell carcinomas were investigated by semiquantitative RT-PCR with specific primers against IDO. The correlations among IDO expression, clinicopathologic factors and prognosis were studied. The expression of IDO was observed in 100% of both of the cancer specimens and the normal mucosa specimens. The IDO expression of the cancer specimens was higher than the normal mucosa specimens. The expression of IDO did not correlate to histological classification, growth pattern, lymphatic invasion, venous invasion, or lymph nodes metastasis, but correlated to clinicopathological stage, the value of immunosuppressive acidic protein (IAP). The group with higher levels of IDO expression had a worse survival rate than the IDO expression group with lower levels. The serum IDO levels of cancer patients were higher than healthy donors measured by semiquantitative RT-PCR and HPLC. It is suggested that the expression of IDO in esophageal squamous cell carcinoma patients may play a pivotal role for immunosuppression of those patients.