Since PNI is measured by serum albumin and lymphocyte counts, low PNI could be indicative of hypoalbuminemia which is reflective of the nutritional status of the patient.23 Malnutrition is known to impact host immunity and therefore cancer outcomes.34 Lymphocyte counts are reflective of cell-mediated immunity which is an essential component of cancer defense. The gene discussed is ALB; the disease is nutritional deficiency disease.