Aim Cytotoxic T-lymphocyte antigen-4 (CTLA-4), an inhibitory molecule on T-cells, plays a key role in tumorigenesis and progression. In the present study, we investigated the effects of three polymorphisms in the CTLA-4 gene on the risk of epithelial ovarian cancer and the clinical outcomes of patients. Methods A case-control study was performed in 527 epithelial ovarian cancer patients and 532 controls. Genotypes of three polymorphisms were determined by polymerase chain reaction/ligase detection reaction. A survival analysis was performed in 346 patients who were followed up for more than 3 years and 208 patients who were followed up for more than 5 years. Results There were significant differences in the genotype and allele distribution frequencies of the rs5742909 C/T polymorphism in CTLA-4 between patients and controls (p = 0.009 and p = 0.04, respectively). Compared with the CC genotype, the CT + TT genotype may significantly decrease the risk of developing epithelial ovarian cancer (OR = 0.69, 95% CI = 0.52-0.91). However, no significant association between the rs231775 G/A and rs3087243 G/A polymorphisms and epithelial ovarian cancer risk was observed. The survival analysis showed that three polymorphisms may not be related to the clinical outcomes of patients. Conclusion Our results suggested that the rs5742909 C/T polymorphism of CTLA-4 may decrease the genetic susceptibility to epithelial ovarian cancer among northern Chinese women.