AbstractObjective(s)Absolute lymphocyte count (ALC) has been shown to be a prognostic indicator in other solid tumors. Given this, we aimed to evaluate the prognostic value of ALC in oral cavity squamous cell carcinoma (OSCC).MethodsUsing our institutional tumor registry data, we identified patients ≥18 years old who were diagnosed with OSCC between 2012 and 2018. Preoperative ALC values within 30 days of surgery were collected through retrospective chart review. American Joint Committee on Cancer, 7th‐edition best stage was used to categorize cancers as early stage (stages 1 and 2) or late‐stage (stages 3 and 4). Primary outcomes were likelihood of recurrence and survival rates after 3 years.ResultsOf the 412 patients identified, 262 patients had available ALC data and met inclusion criteria. Early stage cancer patients who had lymphopenia did not have any significant difference in their rate of death ([OR], 1.71, CI: 0.54–5.45, p = .36) or likelihood recurrence ([OR], 0.60, CI: 0.06–5.87, p = .66) after controlling for age, tobacco use, alcohol use, positive margins, and adjuvant therapy. Late‐stage cancer patients who had lymphopenia also showed no difference in their rate of death ([OR], 2.74, CI: 0.65–11.6, p = .17) or likelihood of recurrence ([OR], 0.38, CI: 0.04–3.36, p = .38).Conclusions and RelevanceThis study evaluates the prognostic value of ALC in oral cavity cancers. Our findings demonstrate that pretreatment ALC is not significantly associated with recurrence and survival outcomes patients with OSCC.Level of EvidenceIIILay SummaryAbsolute lymphocyte count (ALC) has been associated with prognosis in several cancers. We found that preoperative ALC was not associated with likelihood of survival or recurrence in patients with early stage or late‐stage oral cavity cancer.