Alanine aminotransaminase (ALT) and aspartate aminotransaminase (AST) are routinely measured before treating HNSCC. The AST/ALT ratio (De Ritis ratio) has been used to differentiate liver diseases [5, 6]. Bezan et al.  recently demonstrated the AST/ALT ratio was a prognostic factor for non-metastatic renal cell carcinoma, indicating that the AST/ALT ratio may have a prognostic effect in patients with cancers who did not have a liver disease. These results prompted us to investigate the prognostic role of the AST/ALT ratio in patients with HNSCC.