Objective To explore the relationship between the albumin-to-alkaline phosphatase ratio (AAPR) before hepatectomy and clinical prognosis in patients with hepatocellular carcinoma (HCC), and to provide a new idea for improving the prognosis of HCC patients. Methods The clinical data of 132 patients with HCC who underwent hepatectomy at Nantong Tumor Hospital from July 2019 to June 2020 were analyzed retrospectively, they were followed up for 2 years after the operation, and according to their prognosis they were divided into the poor prognosis group (68 cases) and the good prognosis group (64 cases). The levels of albumin, alkaline phosphatase and AAPR were compared between the two groups of patients before operation, and the predictive efficacy of albumin, alkaline phosphatase and AAPR on the prognosis of HCC patients was analyzed by using the receiver operating characteristic (ROC) curve, the general data of the two groups of patients were analyzed by single factor analysis, and the independent risk factors affecting the prognosis of HCC patients were screened through the analysis of multivariate Logistic regression model. Results During the follow-up period, 68 of the 132 HCC patients who underwent hepatectomy had poor prognosis, accounting for 51.52%, there were 51 cases of tumor recurrence, 9 cases of lymph node metastasis, 4 cases of intrahepatic metastasis and 4 cases of pulmonary metastasis; 64 patients had good prognosis, accounting for 48.48%; preoperative albumin and AAPR levels in the poor prognosis group were significantly lower than those in the good prognosis group, while alkaline phosphatase levels were significantly higher than that in the good prognosis group; the ROC curve analysis showed that the area under curve (AUC) of albumin, alkaline phosphatase and AAPR predicting the prognosis of HCC patients after hepatectomy were 0.717, 0.724 and 0.770 respectively, the sensitivity were 48.53%, 57.35% and 83.82% respectively, and the specificity were 92.19%, 81.25% and 65.62% respectively, the AUC and sensitivity of AAPR were higher than those of albumin and alkaline phosphatase; the results of single factor analysis showed that the proportion of patients with tumor diameter ≥?5 cm, microvascular tumor thrombus and preoperative AAPR<0.59 in the poor prognosis group were significantly higher than those in the good prognosis group; through the analysis of multifactor Logistic regression model, the results show that, tumor diameter ≥?5 cm, microvascular tumor thrombus, preoperative AAPR<0.59 were all risk factors for poor prognosis of HCC patients after hepatectomy (OR=2.344, 2.477, 2.743, all P<0.05). Conclusion Preoperative AAPR is closely related to the clinical prognosis of HCC patients undergoing hepatectomy, it has a high predictive value for the prognosis of HCC patients, tumor diameter ≥?5 cm, microvascular tumor thrombus, and preoperative AAPR<0.59 are all important risk factors affecting the poor prognosis of patients undergoing hepatectomy, in order to improve the prognosis of HCC patients undergoing hepatectomy to the greatest extent and prolong their survival period, the patients with those condition should be treated appropriately.