Indeed, recent clinical calculators for survival in patients with metastatic colorectal cancer, based on data of more than 20,000 patients from randomised controlled trials (ARCAD database), has incorporated the white cell count, neutrophil count, platelet count and albumin level as scores rather than derived ratios.9,10 Furthermore Dupré and Malik11 have argued that the variability of reported prognostic thresholds of NLR, PLR and LMR questions their reliability for routine clinical practice. This evidence concerns the gene ALB and metastatic colorectal cancer.