Purpose: Galectin-9, a member of the h-galactoside^binding galectin family, induces aggregation of certain cell types.We assessed the contribution of galectin-9 to the aggregation of breast cancer cells as well as the relation between galectin-9 expression in tumor tissue and distant metastasis in patients with breast cancer. Experimental Design: Subclones of MCF-7 breast cancer cells with high or low levels of galectin-9 expression were established and either cultured on plastic dishes or transplanted into nude mice. The tumors of 84 patients with breast cancer were tested for galectin-9 expression by immunohistochemistry. The patients were followed up for 14 years. Results: MCF-7 subclones with a high level of galectin-9 expression formed tight clusters during proliferation in vitro, whereas a subclone (K10) with the lowest level of galectin-9 expression did not. However, K10 cells stably transfected with a galectin-9 expression vector aggregated in culture and in nude mice. Ectopic expression of galectin-9 also reduced MCF-7 cell adhesion to extracellular matrix proteins.Tumors of 42 of the 84 patients were galectin-9 positive, and those of 19 of the 21patients with distant metastasis were galectin-9 negative. None of the13 patients with galectin-9^positive tumors and lymph node metastasis up to level II manifested distant metastasis.The cumulative disease-free survival ratio for galectin-9^positive patients was more favorable than that for the galectin-9^negative group (P < 0.0001). Multivariate analysis revealed that galectin-9 status influenced distant metastasis independently of and to a greater extent than lymph node metastasis. Conclusions: Galectin-9 is a possible prognostic factor with antimetastatic potential in breast cancer.Distant metastasis is a major clinical determinant of the survival of individuals with breast cancer. The number of lymph node metastases (node status) has long been used to predict distant metastasis in breast cancer. The various biological markers proposed for the prediction of distant metastasis in breast cancer include loss of nm23 expression (1, 2), with increased expression of this gene induced by inhibition of DNA methylation also having been found to prevent distant metastasis (3). The levels of both total and low molecular weight cyclin E, as determined by immunoblot analysis, are also correlated with survival in patients with breast cancer, especially in those with node-negative cancer (4).However, none of these biological markers is as effective as node status in the prediction of distant metastasis or is suitable as an indicator of the need for adjuvant chemotherapy.Galectin-9 is a member of the h-galactoside-binding galectin family of proteins (5-8). Among the members of the galectin family, galectin-1 (9) and galectin-3 (10 -13) contribute to tissue invasion by and metastasis of several types of cancer cells, including breast cancer cells. Galectin-3 also serves as a marker for preoperative diagnosis of nodular thyroid lesions (14). We have recently shown ...