Abstract: Objective To investigate the value of joint score of platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI) to predict postoperative recurrence and mortality of patients with hepatocellular carcinoma (HCC) after liver resection. Methods Clinical data of HCC patients within Milan criteria who underwent liver resection at our center were retrospectively reviewed (n=269). The preoperative PLR and PNI of all patients were measured, and. the score of PLR+PNI was calculated. The patients with high PLR (≥ 150) and low PNI (<45) were allocated a score of 2; while the patients had one or neither of these elevations were allocated a score of 1 or 0, respectively. Postoperative survival was estimated by Kaplan-Meier method with log-rank test. Multivariate analysis used Cox regression model. Results Multivariate analysis showed microvascular invasion, high alpha-fetoprotein (AFP) level, multiple tumors and PLR+PNI score were associated with postoperative recurrence. Microvascular invasion, transfusion and PLR+PNI score were independent risks factors for overall survival. The 5-year recurrence-free survival rates for the patient with PLR+PNI score of 0, 1, 2 were 43.4%, 27.8%, and 19.9% respectively (P<0.001). The 5-year overall survival rates were 84.1%, 72.3%, and 17.7% respectively (P<0.001). Conclusion High PLR+PNI score seems related to high incidence of postoperative recurrence and low long-term survival in the patients with HCC after liver resection.