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Background:The absolute lymphocyte counts (ALCs) have been reported as one of worse prognostic factors for hepatocellular carcinoma (HCC) patient after liver transplantation.The aim of this study was to assess the influence of ALCs on the outcomes of patients with hepatitis B virus (HBV)-related HCC within the Milan criteria following liver resection.Methods:Data of patients with HCC within the Milan criteria who received liver resection between January 2007 and June 2013 were reviewed,and perioperative ALCs were carefully monitored.All potential risk factors were statistically analyzed by uni-and multi-variate analyses.The receiver operating characteristic (ROC) curve was used to determine the optimalALCs cut-offvalue to predict HCC recurrence after liver resection.Results:A total of 221 patients were enrolled in the current study.During the follow-up period,106 patients experienced recurrence,and 38 patients died.Multivariate analysis suggested microvascular invasion (MVI),a tumor grade ≥2,and a low postoperative ALCs in the 1st postoperative month increased the incidence of postoperative recurrence,besides,MVI,intraoperative transfusion,and a low postoperative ALCs in the 1 st postoperative month were associated with poor overall survival (OS).An ROC analysis showed that a cut-offvalue of 1.5 × 109/L for ALCs in the 1st postoperative month predicted postoperative recurrence.The 5-year recurrence-free survival (RFS) and OS rates of patients with low postoperative ALCs were 34.5％ and 64.8％,respectively,which were significantly lower than those of patients with high postoperative ALC (58.5％ for RFS and 86.5％ for OS).Conclusion:Low ALCs in the 1st postoperative month may be associated with high recurrence incidence and poor OS for patients with HBV-related HCC within the Milan criteria after liver resection.