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Background/Purpose: Accurate staging is the first step for optimal treatment selection in patients with nasopharyngeal carcinoma (NPC). In this propensity-score-matched, population-based cohort study, we investigated the survival effects of pretreatment 8-fluorodeoxyglucose positron emission tomography–computed tomography (18FDG-PET–CT) on patients with NPC. Methods: We included patients with stage I–IVA NPC receiving radiotherapy or concurrent chemoradiotherapy and categorized them into two 1:1 propensity score–matched groups according to whether or not they underwent pretreatment 18FDG-PET–CT and compared their outcomes. Results: Of the 10,756 patients, propensity score matching yielded 4366 patients in each group. According to multivariable Cox regression analyses, the most prominent correlation between pretreatment 18FDG-PET–CT and all-cause death was observed in patients with stage II NPC (adjusted hazard ratio [aHR], 0.77; 95% confidence interval [CI], 0.60–0.90; P = .0433), followed by patients with stage III NPC (aHR, 0.81; 95% CI, 0.69–0.94; P = .0071) and patients with stage IVA NPC (aHR, 0.88; 95% CI, 0.79–0.97; P = .0091). This association was not significant in patients with stage I NPC (aHR, 1.20; 95% CI, 0.75–1.93; P = .4426). Conclusion: Pretreatment 18FDG-PET–CT is associated with longer survival in patients with clinical stage II–IVA NPC but not in stage I NPC.