BACKGROUND: Due to the poor prognosis of non-small cell lung cancer (NSCLC) patients, precise and reliable biomarkers are urgently needed to predict the prognosis in NSCLC patients after radical lung surgery. Hence, this study sought to investigate the correlation between the monocyte-to-high-density lipoprotein ratio (MHR) and overall survival (OS) in NSCLC patients after surgery. METHODS: This retrospective study analyzed clinical data, including MHR, from NSCLC patients undergoing radical surgery. OS was calculated to evaluate the prognosis of the NSCLC patients. The association between the MHR and OS was analyzed. A receiver operating characteristic (ROC) curve analysis was conducted to evaluate the 3- and 5-year predictive value of the MHR for prognosis after surgery. RESULTS: In total, 256 patients were enrolled in this study. All patients had a follow-up for more than 5 years. The prognosis of the patients with a higher MHR (>
0.3) was worse than that of the patients with a lower MHR (≤0.3) (P<
0.002). The univariate Cox survival analysis showed that the MHR, surgery time, tumor (pT) stage, lymph node (pN) stage, and sex were all significantly associated with the risk of death in patients with NSCLC. The multivariate Cox survival analysis showed that the MHR [hazard ratio (HR) =24.837, 95% confidence interval (CI): 7.265-84.911], T stage, N stage, and surgery time were prognostic factors for NSCLC patients after surgery. The stratified analysis, which excluded patients with tumors CONCLUSIONS: The MHR was found to be an independent predictor of OS in NSCLC patients after radical surgery. Early monitoring and reducing the MHR may be of great significance in preventing disease recurrence and improving patient prognosis.