〔Abstract〕 Objective To explore the expression of M2 pyruvate kinase(PKM2), cyclooxygenase 2(COX2) and inhibitor of apoptosis protein(IAPs) in cancer tissues of patients with primary liver cancer(PLC) and its relationship with radiotherapy sensitivity. Methods A total of 105 PLC patients who underwent three-dimensional conformal radiation therapy(CRT) were enrolled. Liver cancer tissues were collected by liver needle biopsy. The expression of PKM2, COX2 and IAPs protein families [X-linked inhibitor of apoptosis protein(XIAP), cellular inhibitor of apoptosis protein 1(cIAP-1)] in liver cancer tissues was detected by immunohistochemistry. The differences in expression of PKM2, COX2, XIAP and cIAP-1 in cancer tissues among patients with different radiotherapy effects and sensitivity were compared. The relationship between the expression of above-mentioned proteins and prognosis was analyzed. Results The positive expression rates of PKM2, COX2, XIAP and cIAP-1 in liver cancer tissues of the 105 patients were 81.90%, 74.28%, 85.71% and 82.86%, respectively. There were significant differences in response rate of treatment between patients with positive expression of COX2 and XIAP and those with negative expression(P<0.05). There were significant differences in clinical staging, differentiation degree, tumor diameter, expression of PKM2, COX2, XIAP and cIAP-1 in liver cancer tissues between patients with radiotherapy sensitivity and those without radiotherapy sensitivity(P<0.05). High clinical staging, poor differentiation, positive expression of COX2 and XIAP were independent risk factors of radiotherapy insensitivity(P<0.05). There were significant differences in recurrence rate and metastasis rate between patients with positive expression of XIAP and those with negative expression(P<0.05). Conclusion The positive rates of PKM2, COX2, XIAP and cIAP-1 are high in liver cancer tissues of PLC patients. The expression of COX2 and XIAP is closely related to radiotherapy effect and sensitivity, and the expression of XIAP is also related to recurrence and metastasis.