TNF and malnutrition: Serum albumin is closely related to the degree of malnutrition and the prognosis of patients with gastric cancer.15 Low serum albumin level is related to the increase of tumor-associated inflammatory reactions, which may be caused by the decrease in albumin production by hepatocytes due to the release of inflammatory cytokines by tumor cells.16 Additionally, serum albumin can bind to and activate prostaglandin E2 (PGE2), which down-regulates macrophage-derived tumor necrosis factor-α (TNF-α) and promotes immunosuppression.17