Objectives To evaluate the prognostic sensitivity of neutrophil to lymphocyte ratio (NLR) to bladder perfusion chemotherapy in patients with non-muscle invasive bladder cancer(NMIBC). Methods Sixty-three patients diagnosed as NMIBC from June 2012 to December 2014 were collected. All patients received bladder perfusion chemotherapy regularly after transurethral resection of bladder tumor (TURBT). The main end point was tumor recurrence or progression. The differences of NLR before TURBT, NLR after one-month chemotherapy and the NLR difference between recurrent and non-recurrent patients were calculated. Results A total of 21 patients had bladder cancer recurrence, with the median follow-up time of 9 months. The mean value of NLR before TURBT and NLR after one-month chemotherapy of recurrent patients (2.34±1.28), (2.65±0.95) and non-recurrent patients (2.75±1.68),(2.24±1.05) was demonstrated no statistical difference (P=0.33, 0.135, respectively). However, the NLR difference of non-recurrent patients was much lower than recurrent patients [mean value was(-0.51±1.64)and(0.31±1.20), respectively, P=0.046], demonstrating significant statistical difference. Conclusions NLR difference can be used as an attractive and easily-accessible prognostic and predictive biomarker to evaluate the therapeutic efficacy of bladder perfusion chemotherapy to NMIBC patients. The lower NLR difference during chemotherapy, the more benefits patients can achieve.