INTRODUCTION: To explore whether the association between preoperative neutrophil-to-lymphocyte ratio (NLR) elevation and worse survival is of use prognostically or merely a reflection of medical comorbidities in clear cell renal cell carcinoma (CC RCC). MATERIALS AND METHODS: We identified 1970 patients treated at Memorial Sloan Kettering Cancer Center from 1998-2012 by partial or radical nephrectomy for non-metastatic CC RCC. NLR was calculated by dividing absolute neutrophil count by absolute lymphocyte count; both were obtained from preoperative complete blood count. Uni- and multivariable Cox proportional hazards regression, which included established prognostic variables, were used to test for association between NLR and recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS). RESULTS: Univariate analysis identified elevated NLR as significantly associated with worse RFS, CSS, and OS (all p < 0.0001). However, upon multivariable analysis, elevated NLR was significantly associated with only worse OS (p < 0.0001). After adding markers of comorbidity that were significantly correlated with NLR elevationhigher American Society of Anesthesiologists class (p = 0.013), older age, and higher estimated glomerular filtration rate (both p < 0.0001)-into the multivariable model, NLR remained significantly associated with OS (p = 0.001). The addition of NLR into the prognostic model for OS did not increase Harrell's concordance index from 0.776. CONCLUSIONS: In our cohort, preoperative NLR elevation is associated with worse OS, but there was no significant association with RFS or CSS on multivariable analysis. Preoperative NLR does not add unique prognostic information for patients undergoing surgical resection of renal tumors.