OBJECTIVE: This study analyzed the prognosis of patients with high-grade squamous intraepithelial lesion (HSIL) after loop electrosurgical excision procedure (LEEP) and elucidated the predictive value of neutrophil-to-lymphocyte ratio (NLR) and margin condition in relation to prognostic recurrence. METHODS: A total of 209 patients were included, with 46 cases in the recurrence/residual group, 156 cases in the no recurrence/residual group, and 7 cases lost to follow-up. General information, past history and comorbid underlying diseases, laboratory tests, and other relevant clinical information were compared between the two groups. The ROC curves were plotted to assess the diagnostic values of NLR, platelet-to-lymphocyte ratio (PLR), and lymphocytes. Log-rank test was conducted to plot the Kaplan Meier curves to assess the occurrence of recurrence/residual. Risk factors for the occurrence of recurrence/residual in patients during follow-up were analyzed. RESULTS: Patients with high-risk human papillomavirus (HR-HPV) infection, positive margins, and higher PLR and NLR had a higher risk of recurrence/residual at follow-up. HR-HPV infection, positive margins, and higher levels of PLR and NLR showed significant hazard ratios. High NLR, positive margins, and HR-HPV infection resulted in poor prognosis and the occurrence of recurrence or residual. CONCLUSION: NLR levels and positive margins may be markers for predicting HSIL recurrence/residual lesions after LEEP.