Predictive biomarkers are needed to identify patients with oropharyngeal squamous cell carcinoma (OPSCC) that could enjoy treatment de-escalation, with the attendant reduction in incidence of acute and late toxicities. In an observational study of consecutive patients with patients with oropharyngeal squamous cell carcinoma, pretreatment absolute lymphocyte count was predictive for 5-year overall survival. It also predicted benefit from the use of concurrent cisplatin chemotherapy.