We previously reported the increased serum mitochondrial creatine kinase (MtCK) activity in patients with hepatocellular carcinoma (HCC), mostly due to the increase in ubiquitous MtCK (uMtCK), and high uMtCK mRNA expression in HCC cell lines. We explored the mechanism(s) and the relevance of high uMtCK expression in HCC. In hepatitis C virus core gene transgenic mice, known to lose mitochondrial integrity in liver and subsequently develop HCC, uMtCK mRNA and protein levels were increased in HCC tissues but not in non-tumorous liver tissues. Transient overexpression of ankyrin repeat and suppressor of cytokine signaling box protein 9 (ASB9) reduced uMtCK protein levels in HCC cells, suggesting that increased uMtCK levels in HCC cells may be caused by increased gene expression and decreased protein degradation due to reduced ASB9 expression. The reduction of uMtCK expression by siRNA led to increased cell death, and reduced proliferation, migration and invasion in HCC cell lines. Then, consecutive 105 HCC patients, who underwent radiofrequency ablation with curative intent, were enrolled to analyze their prognosis. The patients with serum MtCK activity >19.4 U=L prior to the treatment had significantly shorter survival time than those with serum MtCK activity 19.4 U=L, where higher serum MtCK activity was retained as an independent risk for HCC-related death on multivariate analysis. In conclusion, high uMtCK expression in HCC may be caused by hepatocarcinogenesis per se but not by loss of mitochondrial integrity, of which ASB9 could be a negative regulator, and associated with highly malignant potential to suggest a poor prognosis.Primary liver cancer, 95% of which is hepatocellular carcinoma (HCC), is ranked third in men and fifth in women as a cause of death from malignant neoplasms in Japan.1 Furthermore, the worldwide incidence of HCC has increased over several decades, and HCC has recently received considerable attention as a common cause of mortality.2 HCC often arises in background of liver cirrhosis, which is formed as a result of chronic viral infections, alcoholic injury and some other disorders in the liver.3,4 Of note, HCC has recently been linked to non-alcoholic fatty liver disease, and this association may contribute to the rising incidence of HCC witnessed in many industrialized countries. It is also problematic that HCC may complicate non-cirrhotic, nonalcoholic fatty liver disease with mild or absent fibrosis, greatly expanding the population potentially at higher risk.