High DcR3 expression predicts stage pN2-3 in gastric cancer

Background: A soluble decoy receptor 3 (DcR3), also known as TR6 or M68, is a member of the TNF receptor family. It has been reported that high DcR3 expression occurs in many tumors. Methods: This prospective study evaluated the DcR3 tissue status by RT-PCR and its correlation with the lymph node (N) stages in 62 primary gastric cancers. Results: DcR3 expression levels in patients with pN2-3 disease were much higher than those in patients with pN0-1 disease (median values 1.31 vs. 0, P < 0.01). Using ROC analysis, a cutoff level of DcR3 expression at 1.20 was found to be associated with optimal sensitivity and specificity of 62.5% (15 of 24) and 92.1% (35 of 38) respectively, in the prediction of stage pN2-3. According to the cutoff value, patients were divided into 2 groups with relatively high and low levels of DcR3 expression. Among the 18 patients with high DcR3 expression, 83.3% (15 of 18) were staged as pN2-3. In the other 44 patients with low DcR3 expression, only 20.5% (9 of 44) were identified as pN2-3. Logistic regression analysis for stage pN2-3 revealed that high DcR3 expression was an independent risk factor. Conclusion: Gastric cancer patients with high DcR3 expression presented more advanced pN2-3 disease than those with low DcR3 expression. Preoperative checking DcR3 expression might be an additional approach to imaging modalities for evaluating N stages in gastric cancer to guide the operative procedures.