With regard to the prognostic value of telomere length, previous data were conflicting. For example, short telomeres correlated with poor prognosis in chronic lymphocytic leukemia, colorectal cancer, and prostate cancer 18, but with favorable prognosis in esophageal and breast cancers 42, 43. For HCC, two Chinese studies reported that patients treated with transarterial chemoembolization with longer leukocyte RTL had a shorter survival time 44, 45. In a Korean cohort containing 49 HCC patients, patients with a higher RTL tumor/non‐tumor ratio had a relatively poorer survival 37, while in a US cohort of 126 HCC patients, there was no association between telomere length and patient survival 38. The discrepancy in these results could be attributed to differences in follow‐up duration, baseline clinicopathologic characteristics, therapeutic schedules, and/or study populations. We noted that in the US cohort, the time interval for selection of these multi‐racial cases was 39 years, and detailed treatment data were lacking or changed over the years 35. It is known that dissimilarity of telomere length is found among multi‐racial populations 11. In this study, as the largest integrative analysis of telomere length in HCC to date, 257 Chinese patients who received curative surgical resection were randomly selected within 1 year, most of whom were HBV‐related cases. In addition, the method used in this study can evaluate cancer cells individually, while others evaluated tumor tissues as a whole. Using internal and external validation datasets, we demonstrated that shortened telomeres in tumor cells were independently and significantly associated with poor clinical outcome in HCC patients.