BACKGROUND.: Currently, to the authorsʼ knowledge, there is no serum marker to predict disease recurrence after patients undergo curative resection for gastric carcinoma. Previous reports have indicated that serum levels of soluble E-cadherin had prognostic value in these patients. The objective of the current study was to determine whether soluble E-cadherin levels could predict disease recurrence in patients with gastric carcinoma who underwent curative surgery. METHODS.: Sixty-nine patients who underwent curative surgery for gastric carcinoma after December 1997 were followed prospectively. Venous blood samples were collected preoperatively, 1 month after surgery, and every 3 months thereafter. The blood samples were assayed for soluble E-cadherin and for carcinoembryonic antigen (CEA) using commercial enzyme-linked immunosorbent assay kits. Receiver operating characteristic (ROC) curves were used to define a cut-off level of E-cadherin for the optimal sensitivity and specificity for predicting disease recurrence. RESULTS.: The median follow-up was 21 months for patients with recurrent disease (n = 17 patients) and 36 months for patients without recurrent disease (n = 52 patients; P = 0.007). The optimal cut-off level of E-cadherin was 10,000 ng/mL. The sensitivity for predicting prediction disease recurrence using this cut-off level at 3 months and at 6 months postsurgery was 47% and 59% respectively, which was significantly better compared with the sensitivity of CEA using the conventional cut-off level (6% at 3 months postsurgery and 6% at 6 months postsurgery; P = 0.004 and P < 0.0001, respectively). The median time between the elevated E-cadherin level and documented disease recurrence was 13 months (range, 3–20 months), compared with 4 months (range, 1–20 months) for CEA. CONCLUSIONS.: Serum soluble E-cadherin was a good marker for predicting disease recurrence in the first 3–6 months after surgery, with a median of 13 months before clinical recurrence. The use of this marker may allow time for vigilant surveillance and consideration of adjuvant therapy. Cancer 2005. © 2005 American Cancer Society.The authors investigated the role of serum soluble E-cadherin in predicting tumor recurrence in patients who underwent curative resection of gastric carcinoma. Using a cutoff level of 10,000 mg/mL, they found the sensitivity to be 47% and 59%, respectively, at 3 months and 6 months after surgery, findings that were significantly better than that of carcinoembryonic antigen using a conventional cutoff level (6% and 6%,respectively, with corresponding P values of 0.004 and < 0.0001, respectively). The authors conclude that serum soluble E-cadherin is a good marker for the prediction of disease recurrence in the first 3–6 months after surgery.