Objective Exploration (SEMA3F), transcriptional activator 4 (ATF 4) expression in laryngeal cancer tissue and predictive value of postoperative recurrence and metastasis. Methods A total of 60 patients who were treated for laryngeal cancer in the Affiliated Hospital of Putian University from August 2016 to August 2022, 37 patients with pathologically confirmed postoperative recurrence and metastasis were divided into recurrence and metastasis group, and the other 23 patients without postoperative recurrence and metastasis were divided into no recurrence and metastasis group. The positive rates of SEMA3F and ATF 4 were determined by immunohistochemistry and SEMA3F and ATF 4 by RT-PCR. The predictive value of SEMA3F and ATF 4 for postoperative recurrence and metastasis in patients with laryngeal cancer was analyzed. Results Compared with the non-recurrent metastasis group, SEMA3F expression and ATF 4 expression decreased in laryngeal carcinoma tissue; SEMA3F mRNA expression decreased and ATF4 mRNA expression increased (P<0.05). Compared with the unmetastatic group, the expression levels of carcinoembryonic antigen (CEA), sugar antigen 199 (CA199), and sugar antigen 125 (CA125) were decreased in the metastatic group (P<0.05). Logistic Regression analysis showed that CEA, CA199, CA125, SEMA3F, and ATF 4 were independent risk factors for postoperative recurrence and metastasis in patients with laryngeal cancer. The ROC curve showed that the diagnostic efficacy of the combination test to predict recurrence and metastasis after laryngeal cancer was significantly higher than the single test of SEMA3F and ATF 4. Conclusion SEMA3F, ATF 4 is a risk predictor of postoperative recurrence and metastasis in laryngeal cancer patients, and it has a higher application value in the diagnosis of recurrence and metastasis after laryngeal cancer surgery.