Objective: To investigate the relationship between the preoperative platelet-to-lymphocyte ratio (PLR) and prognosis of hepatocellular carcinoma (HCC). Methods: The clinical data of 256 HCC patients undergoing surgical treatment were retrospectively analyzed. According to the preoperative PLR level of the patients, the receiver operating characteristic (ROC) curve was drawn, the cut-off value was determined, and the relations of the preoperative PLR level with the clinicopathologic factors and prognosis of the patients were analyzed. Results: The area under the curve of ROC of PLR for diagnosis of tumor recurrence was 0.625 (95% CI=0.544–0.706), with a sensitivity of 0.53, specificity of 0.70, and cut-off value of 131.81. The preoperative PLR level was significantly associated with the clinicopathologic factors that included preoperative serum albumin level, Child-Pugh liver function classification, the presence or absence of ascites, vascular invasion, and TNM stage (all P<0.05). Cox hazards model analysis identified that TNM stage (HR=1.441, 95% CI=1.721–2.635, P<0.001) and PLR level (HR=1.737, 95% CI=1.317–2.291, P<0.001) were independent prognostic factors for HCC, and PLR level (HR=1.893, 95% CI=1.434–2.497, P<0.001) was independent prognostic factor for HCC recurrence. Survival analysis showed that the preoperative 1-, 3- and 5-year tumor-free survival rate in patients with low preoperative PLR level (81.2%, 52.3% and 29.6%) were significantly higher than those in patients with higher preoperative PLR level (62.4%, 32.2% and 11.6%). Conclusion: Preoperative PLR can be used as a prognostic marker for HCC patients, and those with high PLR level may have a high risk of recurrence and poor prognosis.