Background: To analyze the value of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in the survival of patients with parotid cancer. Methods: In total, 249 patients were enrolled. Information including age, sex, pretreatment NLR, and pathologic variables such as, tumor stage, intraparotid node (IPN) metastasis, and follow-up findings was extracted and analyzed. Results: IPN metastasis was noted in 45 (18.1%) patients, and the mean NIA was 2.48, with a range from 1.5 to 6.1. The NLR was significantly associated with tumor stage, disease stage, and disease grade. A total of 73 patients died of the disease, and the 10 -year disease-specific survival (DSS) rate was 62%. In patients with an NLR<2.48, the 10 -year DSS rate was 68%; in patients with an NLR >= 2.48, the 10 -year DSS rate was 58%, and the difference was significant (P=0.006). Cox model analysis showed that the NLR was an independent prognostic factor for DSS. Conclusion: The long-term survival of primary parotid cancer patients is relatively favorable, and the pretreatment NLR is significantly associated with prognosis.