The De Ritis ratio is the proportion of serum AST to ALT levels, which was described by De Ritis et al. in 1957 . This ratio is used for diagnosing and clinical decision-making of liver diseases . Recent studies by Bezan et al.  demonstrated that the AST/ALT ratio is a prognostic factor in non-metastatic renal cell carcinoma, independent of T and N classification. Moreover, they reported that incorporating the AST/ALT ratio to the previously proven prognostic score improved the prognostic value. However, to date, there have been no reports regarding the prognostic value of the AST/ALT ratio in patients with other types of cancer, including HNSCC.