Aim: Nasopharyngeal carcinoma (NPC) is endemic in East and Southeast Asia, with significantly lower incidence in non-endemic areas like Australia. This disparity in prevalence is compounded by limited data from low-risk populations. Our study aimed to characterize the clinicoepidemiological features and long-term outcomes of NPC in an Australian cohort, focusing on differences between Asian and non-Asian patients. Method: We retrospectively analyzed 118 nasopharyngeal tumors diagnosed at Royal North Shore Hospital from 2001 to 2024. Demographics, clinicopathology and treatment outcomes were compared across ethnicities. Regression analyses identified prognostic factors and estimated disease-specific (DSS) and relapse-free survival (RFS). Results: Of 103 NPC patients, the median age at diagnosis was 55.4 years with 72.8% identifying as Asian. Ethnicity (Asian vs non-Asian) was significantly associated with poorer RFS, with Asians (HR=4.73, 95CI 1.01–22.29, p=0.049), T4 stage (HR=4.60, 95CI 1.52–13.96, p=0.007) and distant metastasis (HR=7.85, 95CI 1.45–42.67, p=0.017) having worse outcomes. Definitive treatment yielded complete metabolic response rates of 94.9%, 5-year DSS of 89.7% and RFS of 72.4%. Recurrence lowered 5-year DSS to 36.4% and median survival to 42.6 months, although 27.8% of recurrences occurred beyond 5 years. Ethnic differences in lifestyle factors were noted as more non-Asians smoked (p=0.018) and consumed alcohol (p<0.001) but Asians had higher Epstein-Barr virus (EBV) positivity rates (p=0.033). Keratinizing NPC was linked to smoking (p=0.017) and non-keratinizing NPC was more often EBV positive (p=0.045). Conclusion: NPC in Australia shows notable ethnic disparities, with advanced-stage Asian patients facing worse outcomes, highlighting the need for tailored surveillance and management. With the high risk of late recurrence, we recommend extending follow-up to 7–10 years post-treatment and further research into salvage therapies for recurrent NPC.