Abstract: Objective To evaluate the prognostic value of neutrophil to lymphocyte ratio (NLR) in distal cholangiocarcinoma. Methods From January 2011 to December 2019,clinical data about 115 patients who had undergone distal cholangiocarcinoma surgical treatment in Beijing Chaoyang Hospital Affiliated to Capital Medical University were retrospectively analyzed.NLR was calculated from neutrophil and lymphocyte counts on routine blood tests at one week before surgery.The cut-off value of NLR was determined by ROC curve.According to the cut-off value,the patients were divided into high NLR group and low NLR group,the clinicopathological characteristics and prognosis were compared between the two groups. Results A total of 70 male and 45 female patients were included in the study,with a average age of 64.9±9.2 (29-84) years.Among these patients,tumor in 29 cases were highly differentiated,in 52 cases were moderately differentiated,and in 34 cases were poorly differentiated.The optimal cut-off value of NLR was 3.38 according to the ROC curve,and patients were divided into high NLR group (NLR≥3.38,47 cases) and low NLR group (NLR<3.38,68 cases) according to this cut-off value.No significant difference was found in clinical characteristics between the two groups.The cumulative overall survival rates at 1,3,and 5 years after operation in the high NLR group and the low NLR group were 51.9% vs 89.5%,20.3% vs 51.5%,13.5% vs 43.5%,respectively,with statistically significant difference (all P<0.05). Conclusion Preoperative NLR can predict the prognosis of patients with distal cholangiocarcinoma receiving radical surgery.High NLR is associated with poor prognosis.