Objective: To evaluate the value of neutrophil to lymphocyte ratio (NLR) in predicting microvascular invasion (MVI) in patients with small hepatocellular carcinoma (HCC). Methods: The clinical data of 50 patients diagnosed as small HCC with MVI from June 2012 to June 2017, and 90 patients by random pick from those diagnosed as small HCC without MVI in the same period were retrospectively analyzed. The cut-off value of NLR for diagnosis of MVI was calculated by using receiver operating characteristic (ROC) curve. The risk factors for MVI in patients with small HCC were determined by univariate and unconditional Logistic regression analyses. Results: The cut-off value of NLR for diagnosis of MVI was 3.27, with sensitivity of 0.480, specificity of 0.767 and area under the curve (AUC) of 0.613 (95% CI=0.511 0.715, P=0.027). Univariate analysis showed that the proportions of cases with AFP>25 ng/mL, maximum tumor diameter larger than 3 cm and NLR>3.27 in patients with MVI were singinifcantly higher than those in patients without MVI (all P<0.05); unconditional logistic regression analysis revealed that NLR, AFP level and maximum tumor diameter were independent risk factors for small HCC with complicated MVI (all P<0.05). In addition, the variables that included AFP, neutrophil, lymphocyte, blood platelet, albumin and maximum tumor diameter in patients with NLR≤3.27 were significantly superior to those in patients with NLR>3.27 (all P<0.05). Conclusion: Preoperative NLR value is one of the independent risk factors for complicated MVI in patients with small HCC, and it can be a simple to use and practicable indicator in clinical practice. Patients with NLR>3.27 may have a higher likelihood of MVI.