Objective: To investigate the value of preoperative peripheral blood neutrophil-lymphocyte ratio (NLR) in estimating the prognosis in elderly patients (75 years of age and older) after radical surgery for colon cancer. Methods: The clinical data of 67 colon cancer patients over 75 years of age undergoing radical surgery in Department of General Surgery of Liaohe Oil Field General Hospital from January 2008 to January 2013 were collected. The relations of preoperative NLR values of the patients with the clinicopathologic factors and postoperative survival rates were analyzed. Results: According to the cut-off point of NLR (2.98), the patients were divided into low NLR group (NLR<3) and high NLR group (NLR≥3), with 44 cases in the former and 23 cases in the latter. The degree of tumor differentiation was poorer (P=0.040), lymph node metastasis rate was higher (P=0.018), TNM stage was more advanced (P=0.008) and CEA level was higher (P=0.026) in high NLR group than those in low NLR group. The overall postoperative 3-year survival rate in the whole group of patients was 62.7%, which in low NLR group and high NLR group was 72.7% and 43.5% respectively, and the difference had statistical significance (P<0.05). Univariate analysis showed that the preoperative NLR value together with the degree of tumor differentiation, TMN stage, lymph nodes metastasis and CEA level were significantly associated with the postoperative survival of the patients (all P<0.05). Conclusion: Preoperative NLR has certain value in prognostic estimation for elderly colon cancer patients after radical surgery, and those with high NLR level may face an unfavorable prognosis.