Blood neutrophil-to-lymphocyte ratio (NLR) is one index representing systemic inflammation, and high preoperative NLR has been suggested as an independent prognostic factor in HCC. However, the NLR cutoff value with the highest prognostic significance is not consistent, and the mechanism of this phenomenon remains unclear. Preoperative NLR was calculated from complete blood counts obtained before 14 days from operation day in 234 patients who underwent curative resection for primary HCC. The presence of tumor necrosis and degree of tumor-infiltrating lymphocytes (TILs) was determined histologically. High preoperative NLR (≥ 2.5) was observed in 28 (12.0%) of 234 HCCs and was significantly associated with younger age, larger tumor size, high Edmonson grade, microvascular invasion, major portal invasion, advanced AJCC T or BCLC stage, and low albumin level. Patients with high preoperative NLR showed shorter disease-specific survival (DSS) (p = 0.002) and a tendency for shorter recurrence-free survival (RFS) (p = 0.096). High preoperative NLR was associated with presence of tumor necrosis and low TIL. On multivariable analysis, preoperative NLR was an independent prognostic factor for DSS (hazard ratio: 2.050 (95% confidence interval 1.139–3.691), p = 0.017). However, the independent prognostic effect of NLR for DSS disappeared when tumor necrosis and TILs were added as co-variables. High NLR is an independent prognostic factor in patients with HCC who undergo curative resection. The prognostic effect of high NLR might originate from the prognostic effect of tumor necrosis or TILs.

血液中性粒细胞与淋巴细胞之比（NLR）是代表全身性炎症的一项指标，术前较高的NLR被认为是HCC的独立预后因素。然而，具有最高预后意义的NLR截止值并不一致，并且这种现象的机制仍不清楚。234例接受原发性肝癌根治性切除术的患者，从手术日14天前获得的全血计数计算出术前NLR。通过组织学确定肿瘤坏死的存在和肿瘤浸润淋巴细胞（TILs）的程度。在234例HCC中，有28例（12.0％）发生了较高的术前NLR（≥2.5），这与年龄较小，肿瘤较大，埃德蒙森分级高，微血管浸润，主要门静脉浸润，AJCC T或BCLC晚期有关，和低白蛋白水平。术前NLR较高的患者显示疾病特异性生存期（DSS）较短（p  = 0.002）和无复发生存期（RFS）较短的趋势（p  = 0.096）。术前NLR高与肿瘤坏死和TIL低有关。在多变量分析中，术前NLR是DSS的独立预后因素（危险比：2.050（95％置信区间1.139-3.691），p  = 0.017）。但是，当肿瘤坏死和TIL作为协变量加入时，NLR对DSS的独立预后作用消失了。高NLR是接受根治性切除的HCC患者的独立预后因素。高NLR的预后作用可能源自肿瘤坏死或TIL的预后作用。