Gastric cancer is the fifth most common cancer in the world and the third leading cause of cancer-related death (1). The outcomes of gastric cancer have been improved by gastrectomy with D2 lymph-node dissection and advances in chemotherapy (2). The Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer (ACTS-GC) demonstrated that 1 year of adjuvant chemotherapy with S-1, an oral fluoropyrimidine, significantly improves outcomes in patients with stage II/III gastric cancer who undergo gastrectomy with D2 dissection (3). However, recurrence rates after curative resection and adjuvant chemotherapy remain high in gastric cancer. In the ACTS-GC study, the 5-year overall survival (OS) rate was 84.2% in those with stage II disease, 67.1% in those with stage IIIA disease, and 50.2% in those with stage IIIB disease, even after adjuvant chemotherapy with S-1 (4). Further improvements in outcomes are likely to require personalized therapy based on biomarker analysis.We have searched for biomarkers of gastric cancer using DNA microarray analysis in patients with stage II/III gastric cancer who underwent curative resection and received adjuvant chemotherapy with S-1. We found that expression of the human tensin 4 (TNS4) gene in gastric cancer tissue was 23.52-times higher than that in paired adjacent normal mucosa (unpublished data). We, thus, focused on the clinical significance of TNS4 gene expression in gastric cancer.TNS4 is a member of the tensin gene family (5) and is also known as COOH-terminus tensin-like molecule (CTEN) (6). This gene family comprises four members (TNS1, TNS2, TNS3, and TNS4) and their products are localized in the cytoplasmic tails of integrins at focal adhesions. Tensins play important roles in various biological processes, such as cell adhesion, migration, proliferation, differentiation, apoptosis, and invasion (6-9). TNS4 expression is up-regulated in many cancer types (10)(11)(12)(13)(14), suggesting that overexpression of TNS4 may play a critical role in tumorigenesis.In this study, we evaluated the clinical significance of the relative expression of TNS4 in patients with stage II/III gastric cancer who underwent curative resection followed by adjuvant chemotherapy with S-1.