['There is limited information available concerning the delta neutrophil to lymphocyte ratio (ΔNLR) in hepatocellular carcinoma (HCC). The present study was designed to evaluate the predictive value of dynamic change of NLR in patients who undergo curative resection for small HCC.', 'A retrospective cohort study was performed to analyze 189 patients with small HCC who underwent curative resection between February 2007 and March 2012. Patient data were retrieved from our prospectively maintained database. Patients were divided into two groups: group A (NLR increased, n\xa0=\xa080) and group B (NLR decreased, n\xa0=\xa0109). Demographic and clinical data, overall survival (OS), and recurrence-free survival (RFS) were statistically compared and a multivariate analysis was used to identify prognostic factors.', 'The 1, 3, and 5-y OS in group A was 92.7, 70.0, and 53.0%, respectively, and 96.2, 87.5, and 75.9%, respectively, for group B (P\xa0=\xa00.003); The corresponding 1, 3, and 5-y RFS was 58.7, 37.9, 21.8, and 81.2%, 58.5% and 53.8% for groups A and B, respectively (P\xa0<0.001). Multivariate analysis suggested that ΔNLR was an independent prognostic factor for both OS (P\xa0=\xa00.004, Hazard Ratio (HR)\xa0=\xa02.637, 95% confidence interval (CI) 1.356-5.128) and RFS (P\xa0<0.001, HR\xa0=\xa02.372, 95% CI 1.563-3.601).'] Do neutrophil to lymphocyte ratio changes predict small hepatocellular carcinoma survival?