Background: Pretreatment Neutrophil-to-lymphocyte ratio (NLR) has been correlated with survival outcome in different types of cancers. In this study we evaluated the prognostic significance of pretreatment NLR in patients with oral squamous cell carcinoma (OSCC). Methods: We retrospectively collected the clinical and epidemiological data of all biopsy proven, non-metastatic OSCC treated in our center between 2009-2015. Pretreatment absolute neutrophils and lymphocytes counts used to obtain NLR. The impact of NLR on overall (OS) and progression free survivals (PFS) was investigated in both uniand multivariate analyses. Results: We identified a total of 68 patients of OSCC with a median pretreatment NLR ratio of 1.79. Patients were classified into two groups; high NLR and low NLR based on median NLR as a cutoff. Elevated NLR was significantly associated with male gender (p = 0.003) and with the presence lymph node metastases (p = 0.029). The 3-years OS and PFS for low and high NLR groups were (69.5% vs. 54.7%, p = 0.037) and (51% vs. 29.5%, p = 0.028), respectively. In multivariate analysis NLR was significant for both OS (p = 0.005) and PFS (p = 0.008). Conclusions: Pretreatment NLR has been shown to be an independent prognostic factor for our patients with OSCC. This provides a simple and easily measurable indicator of outcome. Larger and prospective studies are required to determine the optimal cutoff values to accurately identify NLR related risk groups.