Nectin-like molecule-5 (Necl-5) is an immunoglobulin (Ig)-like molecule that is up-regulated in many types of cancer cells. It was shown experimentally that Necl-5 enhances cell migration, proliferation, and metastasis, but its clinical significance has not been documented. The aim of this study was to observe the expression of Necl-5 in surgically resected primary lung adenocarcinomas and to investigate its clinical significance. A total of 63 surgically resected primary pulmonary adenocarcinoma tissues were investigated by immunohistochemistry for the expression of Necl-5. The relationship between expression of Necl-5 and clinicopathological features was analyzed, and the influence of Necl-5 expression on outcomes in these patients was assessed. A strong expression of Necl-5 by cancer cells was observed in 43 of the 63 tumors. The overexpression of Necl-5 by cancer cells was significantly associated with lymph node metastasis (P = 0.0398), TNM staging (P = 0.0367), and the bronchioloalveolar carcinoma ratio of tumors (P = 0.0423). Furthermore, the disease-free survival rate in patients with positive Necl-5 overexpression was significantly lower than that in patients with negative Necl-5 overexpression (P = 0.0004). Multivariate survival analysis revealed Necl-5 expression to be an independent risk factor for an unfavorable outcome (P = 0.0294). Additionally, an analysis including only the stage I cases revealed that the diseasefree survival rate of the Necl-5-positive group was significantly lower than that of the Necl-5-negative group (P = 0.0192). These results indicate that Necl-5 plays a role in mediating tumor cell invasion and that the overexpression of Necl-5 in cancer cells has clinical significance for prognostic evaluation of patients with primary pulmonary adenocarcinoma. (Cancer Sci 2010; 101: 1326-1330 N ecl-5 ⁄ poliovirus receptor (PVR) ⁄ CD155 ⁄ Tage4 is an immunoglobulin(Ig)-like molecule with a domain structure consisting of one extracellular region with three Ig-like loops, one transmembrane region, and one cytoplasmic region.(1) Human PVR ⁄ CD155 was originally identified as the PVR in a screen of genomic DNA from cells susceptible to poliovirus infection.(2,3) Rodent Tage4 was originally identified in the rat by monoclonal antibody screens to isolate tumor-specific markers of hepatocellular carcinoma (4) and colon carcinoma.(5-8)Tage4 was also found to be expressed in fetal rat liver.PVR ⁄ CD155 was subsequently shown to be overexpressed in many human cancer cells. (9)(10)(11) The PVR ⁄ CD155 gene thus far has been found only in primates and the Tage4 gene has been found only in rodents, but these genes are likely to be derived from a common ancestral gene; (12,13) therefore, PVR ⁄ CD155 and Tage4 were renamed nectin-like molecule-5, or Necl-5. (1,14) Nectins are Ca 2+ -independent Ig-like cell-cell adhesion molecules.(1) Nectin-like molecules (Necls) have been designated as a group of Ig-like molecules with domain structures similar to, but slightly different from, those of nectin.(1)The p...