Univariate analysis of overall survival demonstrated that age, primary site, and stage were the significant prognostic factors for overall survival. Neither AST nor ALT was a significant factor. When the AST/ALT ratio was analyzed as an ordinal variable, HR for second, third, and fourth quartile compared to the first quartile were 1.72, 1.90, and 2.19, respectively (95%CI: 1.09–2.77, 1.21–3.04, and 1.40–3.51, p = 0.020, 0.005, and 0.001, respectively). This indicates that the AST/ALT ratio and HR for death have a linear relationship. Similarly, the AST/ALT ratio as a continuous variable was a significant prognostic factor (HR 1.44, 95%CI: 1.15–1.76, p = 0.022). To exclude possible confounding factors, a multivariate analysis was performed, and the results revealed that the AST/ALT ratio (HR 1.36, 95%CI: 1.08–1.68, p = 0.010), older age, hypopharynx primary, oral cavity primary, and stage IVB were all independent prognostic factors for overall survival.