OBJECTIVE To investigate the prognostic value of pre-treatment neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and hemoglobin level in patients treated with definitive chemoradiotherapy (CRT) for nasopharyngeal carcinoma. METHODS We retrospectively analyzed 97 patients who received definitive CRT for nasopharyngeal cancer. An NLR cut-off value of 4.42 was identified using receiver operating characteristic curve (ROC) analysis, an PLR cut-off value of 128.6 was identified using ROC analysis and a hemoglobin cut-off value of 13g/dl was identified using ROC analysis with overall survival (OS) as an endpoint. RESULTS The 5-year progression-free survival (PFS) and overall survival (OS) for all patients were 67.1% and 72.6%, respectively. The patients with a high NLR (20.6%) had a significantly lower 5-year OS than those with a low NLR (79.4%) (OS: 46.9% vs. 79.7%, p<0.001). The patients with a high PLR (66.3%) had a borderline significant lower 5-year OS than those with a low PLR (32.7%) (OS: 66.1% vs. 87.9%, p=0.055). The patients with a low hemoglobin (18.4%) had a significantly lower 5-year OS than those with a high hemoglobin (80.6%) (OS: 46.6% vs. 78.9%, p<0.001). In univariate analysis, older age, IMRT technique, low hemoglobin and high NLR were prognostic factors. In multivariate analysis, high NLR, low hemoglobin and older age remained independent prognostic factors for OS. CONCLUSIONS Nasopharyngeal cancer tends to be more aggressive in patients with a high NLR and low hemoglobin. These patients should be treated more aggressively, given their unfavorable prognosis.