Background/Aim: Anterior gradient (AGR) proteins, including AGR1, AGR2, and AGR3, which are members of the protein disulfide isomerase family, have been reported as biomarkers for various carcinogenesis processes. Although AGR2 and AGR1 have been demonstrated to be associated with gastric cancer (GC) progression and poor survival, the effect of AGR3 on the progression and prognosis of GC remains unknown. Therefore, our study aimed to examine the expression and prognostic significance of AGR3 in patients with GC. Patients and Methods: We investigated 271 GC patients receiving curative surgery. Formalin-fixed and paraffin-embedded tissue blocks were obtained, and long-term survival analysis was performed. The expression of AGR3 in GC tissues was investigated by quantitative reverse transcription-polymerase chain reaction, western blotting, and immunohistochemistry. Results: AGR3 was overexpressed in GC tissue compared with paired normal tissue at the mRNA and protein levels. AGR3 over-expression was significantly associated with larger tumor size, deeper tumor invasion, lymph node metastasis, and advanced tumor stage. The overall survival of patients with positive AGR3 expression was significantly lower than that of patients without positive AGR3 expression. Multivariate analysis demonstrated that AGR3 and age were independent prognostic factors associated with overall survival. Conclusion: Over-expression of AGR3 was significantly associated with tumor progression and poor survival of GC patients. Therefore, AGR3 may be a novel biomarker and prognostic factor for GC.Gastric cancer (GC) is one of the most prevalent cancer types and the leading cause of cancer-related mortality worldwide, especially in East Asia. Despite recent advances in therapeutic modalities, patients with advanced GC experience rapid disease progression with high morbidity, mortality, and poor survival (1-3). Early diagnosis is crucial to improve the prognosis of GC. Therefore, the search for reliable and practical molecular biomarkers for the early detection and prediction of cancer progression in GC has attracted much attention among clinicians.The protein disulfide isomerase (PDI) family includes thiol oxidoreductase, which mediates the formation, folding, and structural maturation of several substrate proteins in the endoplasmic reticulum (ER) (4-7). Its expression is elevated in a variety of cancers, which is closely related to the invasion and oncogenic phenotypes of tumor cells, and plays a significant role in the progression and prognosis of cancers (8-13).Anterior gradient (AGR) proteins are members of the PDI family involved in secretory and transmembrane proteostasis in the ER (14-16). AGR proteins are composed of three PDIlike proteins including AGR1, AGR2, and AGR3 (14-16). Several studies have suggested that AGR proteins exhibit various cellular functions (e.g., cell migration, differentiation, and proliferation) and pro-oncogenic functions in different types of cancers (14-16).AGR2 is the most described PDI family member and is s...