Objective The aim of the study was to investigate the prognostic value of the preoperative peripheral neutrophil-to-lymphocyte ratio(NLR) in patients with hepatocellular cancer(HCC) and cirrhosis after hepatectomy. Methods This retrospective study included 321 patients with HCC who underwent resection. The NLR was calculated using the neutrophil and lymphocyte counts in routine preoperative blood tests. Receiver operating characteristic curve analysis was performed to select the most appropriate NLR cutoff value. The preoperative NLR, patient demographics, and clinical and pathological data, including disease-free survival(DFS) and overall survival(OS), were analyzed. Results The NLR was correlated with alpha-fetoprotein levels(χ2 = 5.876, P = 0.015), tumor size(χ2 = 32.046, P < 0.001), portal vein tumor thrombus(PVTT; χ2 = 4.930, P = 0.026), tumor encapsulation(χ2 = 7.243, P = 0.007), and recurrence(χ2 = 7.717, P = 0.005). Multivariate analyses illustrated that the number of tumors, PVTT, tumor size, and the NLR were independent factors for predicting DFS and OS. In patients with HCC and cirrhosis, but not among those without cirrhosis, a larger NLR predicted poorer postoperative DFS and OS(both P < 0.001). Conclusion As a simple, effective independent predictor for patients with HCC, the preoperative NLR plays an important role in accurately predicting the postoperative outcomes of patients with HCC and cirrhosis, but not those of patients without cirrhosis. Objective The aim of the study was to investigate the prognostic value of the preoperative peripheral neutrophil-to-lymphocyte ratio (NLR) in patients with hepatocellular cancer (HCC) and cirrhosis after hepatectomy. Methods This retrospective study included 321 patients with HCC who underwent resection . The NLR was calculated using the neutrophil and lymphocyte counts in routine preoperative blood tests. Receiver operating characteristic curve analysis was performed to select the most appropriate NLR cutoff value. The preoperative NLR, patient demographics, and clinical and pathological data, including disease-free Results The NLR was correlated with alpha-fetoprotein levels (χ2 = 5.876, P = 0.015), tumor size (χ2 = 32.046, P <0.001) (PVTT; χ2 = 4.930, P = 0.026), tumor encapsulation (χ2 = 7.243, P = 0.007), and recurrence (χ2 = 7.717, P = 0.005). Multivariate analyzes showed that the number of tumo rs, PVTT, tumor size, and the NLR were independent factors for predicting DFS and OS. In patients with HCC and cirrhosis, but not among those without cirrhosis, a larger NLR predicted poorer postoperative DFS and OS (both P <0.001). As a simple, effective independent predictor for patients with HCC, the preoperative NLR plays an important role in accurately predicting the postoperative outcomes of patients with HCC and cirrhosis, but not those of patients without cirrhosis.