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Background: Many blood markers have been shown to predict the recurrence and survival of various malignancies, but the effects of surgery on the body's inflammatory levels may cause changes in these inflammatory markers. Therefore, in this study, we assessed the relationship between changes in platelet to lymphocyte ratio (PLR) and survival and recurrence in patients with T3-T4 laryngeal squamous cell carcinoma (LSCC). Methods: Data of patients with T3-T4 HSCC were reviewed. Continuous variables were expressed as mean ± SD and were compared using t test or Mann-Whitney U test. The covariate distributions were compared by Chi-square test. Survival curve was estimated by Kaplan-Meier analysis, and Log-Rank test were performed to estimate the survival curve and significance of the difference in survival distribution between groups, respectively. The prognostic value was uncovered by univariate and multivariate Cox hazards analysis. Results: The 413 consecutive patients with LSCC were reviewed. Of these, 362 patients who met the criteria were selected, multi-factor analysis found that pathological T classification(hazard ratio [HR] = 1.878; 95% confidence interval [CI] = 1.342–3.023; P<0.001), pathological N classification (HR = 1.212; 95% CI = 0.867–2.125; P< 0.001) and change of PLR (HR = 2.158; 95% CI = 1.332–2.889; P = 0.004) associated with postoperative recurrence of T3-T4 LSCC. In addition, the pathological T classification (HR = 1.901; 95% CI = 1.255–2.999; P<0.001), pathological N classification (HR = 1.244; 95% CI = 0.810–2.212; P<0.001) and change of PLR (HR = 2.011; 95% CI = 1.354–2.753; P = 0.001) associated with postoperative survival in patients with T3-T4 LSCC. Conclusions: Results demonstrate that change in PLR may serve as a useful prognostic predictor for patients with T3-T4 LSCC. [ABSTRACT FROM AUTHOR]