Abstract. Expression of n-myc downstream regulated gene 1 (ndrG1)/ca 2+ -associated protein 43 (cap43) in cancer cells is a predictive marker of good or poor prognosis depending on tumor type. in this study, we examined whether ndrG1/ cap43 is a marker of good or poor prognosis in gastric cancer patients, and whether it is associated with tumor stromal responses, including angiogenesis and macrophage infiltration. the expression levels of ndrG1/cap43, the number of cd68-positive macrophages and the cd34-positive microvessel density were analyzed by immunohistochemistry in 129 gastric cancer patients, including 65 with the intestinal type and 64 with the diffuse type. the expression of ndrG1/cap43 in the nucleus and the membrane was evaluated. nuclear ndrG1/ cap43 expression was found in 20/65 (30.8%) patients with the intestinal type and in 9/64 (14.1%) patients with the diffuse type of gastric cancer. nuclear ndrG1/cap43 expression was significantly associated with pathological stage in the intestinal type (p=0.002), but not in the diffuse type (p=0.039). nuclear ndrG1/cap43 expression was also closely associated with infiltrating macrophages (P=0.001) and tumor angiogenesis (p=0.001) in the intestinal type. Furthermore, nuclear ndrG1/cap43 expression was associated with poor prognosis in both the intestinal (p=0.001) and the diffuse types of gastric cancer (p=0.047). By contrast, membranous ndrG1/ cap43 expression was not associated with the overall survival of gastric cancer patients with either the intestinal or diffuse type of gastric cancer. the expression of ndrG1/cap43 in the nucleus may be a predictive biomarker for malignant progression in the intestinal type of gastric cancer, preferable to the expression of ndrG1/cap43 in the membrane.Introduction n-myc downstream regulated gene 1 (ndrG1)/ca 2+ -associated protein 43 (Cap43) has been identified as a nickel-and calciuminduced gene, identical to the homocysteine-inducible gene, reduced in tumor (rtp/rit42) and to the differentiation-related gene-1 (drg-1) (1-6). in cancer progression, overexpression of ndrG1/cap43 was found to reduce cell proliferation and anchorage-independent growth in vitro and tumor growth in vivo (2). however, ndrG1/cap43 has no effect on the primary tumor growth of colon and prostate cancer in vivo (7,8). ndrG1/cap43 expression has been found to be increased in numerous types of human cancer in comparison to normal tissues (8). however, other studies have reported that the expression of ndrG1/cap43 is increased in normal cells and in well-differentiated cancer cells, but decreased in poorly differentiated cancer cells and in cancer of the colon, prostate, breast and pancreas (7-11). this suggests a close association of ndrG1/cap43 with the cancer differentiation status. ndrG1/cap43 is a predictive marker of good prognosis in patients with cancer of the prostate, esophagus, breast, colon and pancreas, and with neuroblastoma (2,8,(12)(13)(14)(15). however, the expression of ndrG1/cap43 is a predictive marker of poor prognosis in pa...