Purpose <p>This study evaluated the clinical impact of the neutrophil-to-lymphocyte ratio (NLR) in patients with different stages of colorectal cancer.</p> Methods <p>We retrospectively included patients diagnosed with colon and rectal cancer who underwent colectomy or proctectomy at a single institute between 2017 and 2018. The primary outcome was to investigate the cutoff value of the NLR for 5-year recurrence and survival. The secondary outcome was to evaluate the clinical impact of the NLR according to stage.</p> Results <p>In this cohort of 192 patients, the optimal NLR cutoff value was 4.0. Univariate analyses showed that carcinoembryonic antigen (CEA) level, white blood cell (WBC) count, lymphocyte count, stage, and high NLR were associated with 5-year overall survival (<i>p</i> &lt; 0.001, <i>p</i> = 0.01, <i>p</i> = 0.008, <i>p</i> &lt; 0.001, and <i>p</i> &lt; 0.001, respectively), and multivariate analyses showed that NLR was independently associated with 5-year overall survival (<i>p</i> = 0.013). When stratified by cancer stage, NLR influenced survival outcomes in patients with stage III and IV disease (<i>p</i> &lt; 0.001 and 0.047, respectively).</p> Conclusion <p>A cutoff value of NLR 4.0 is strongly associated with 5-year overall survival in patients with stage III and IV colorectal cancer.</p>