Objective: To investigate the relations of preoperative neutrophil to lymphocyte ratio (NLR) with clinicopathologic characteristics and prognosis of patients with gastric cancer. Methods: The clinicopathologic and follow-up data of 269 patients with gastric cancer treated in the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2011 were retrospectively analyzed. The cutoff value of NLR was 2.4 (susceptibility: 53.3%, specificity: 71.4%) that was determined by receiver operating characteristic curve, and then, according to that, the patients were divided into low NLR group (NLR<2.4, 153 cases) and high NLR group (NLR≥2.4, 116 cases). The differences in clinicopathologic characteristics and survival rates between the two groups of patients were compared, and the prognostic factors for gastric cancer patients were also analyzed. Results: The results of comparison showed that there was no significant difference in age, gender and lymph node metastasis between the two groups (all P>0.05), but the tumor diameter was larger, depth of tumor invasion was deeper, and TNM stage was higher in high NLR group than those in low NLR group (all P<0.05). The overall 5-year survival rate was 44.3% for the entire group, and the results of survival analysis showed that the overall survival rate in high NLR group was significantly lower than that in low NLR group (χ2=17.511, P<0.01). Univariate analysis indicated that the overall survival of the gastric cancer patients was significantly associated with preoperative NLR, tumor size, the depth of tumor invasion and TNM stage (all P<0.05), and multivariate analysis identified that preoperative NLR and tumor size were independent risk factors for the prognosis of gastric cancer patients (both P<0.05). Conclusion: Preoperative NLR is an independent prognostic factor for gastric cancer patients, and high preoperative NLR may associated with unfavorable clinicopathologic conditions and poor prognosis.