Aside from immune markers, elevated Liver enzymes (AST and ALT) >ULN were identified as prognostic factors in univariate analysis for overall survival with ALT proving as independent as also by others in metastatic liver disease.31 It may be speculated that ALT and/or AST rise due to “space-occupying effects” associated with higher tumor burden, which could be confirmed in this patient set. Here, GPT is linked to neoplasm.