AIM: To investigate the possible role of polysaccharide-K (PSK) -related markers in predicting distant metastasis and in the clinical outcome of colorectal cancer (CRC).METHODS: Firstly, we used protein microarrays to analyze the in vitro expression profiles of potential PSK-related markers in the human colorectal adenocarcinoma cell line SW480, which carries a mutant p53 gene. Then, we investigated the clinical implications of these markers in the prognosis of CRC patients. RESULTS: ECA39, a direct target of c-Myc, was identi-fied as a candidate protein affected by the anti-metastat-ic effects of PSK. Immunohistochemistry revealed that ECA39 was expressed at significantly higher levels in tumor tissues with distant metastases compared to those without (P < 0.00001). Positive ECA39 expression was shown to be highly reliable for the prediction of distant metastases (sensitivity: 86.7%, specificity: 90%, posi-tive predictive value: 86.7%, negative predictive value: 90%). A significantly higher cumulative 5-yr disease free survival rate was observed in the ECA39-negative patient group (77.3%) compared with the ECA39-positive patient group (25.8%) (P < 0.05). CONCLUSION: Our results suggest that ECA39 is a dominant predictive factor for distant metastasis in pa-tients with advanced CRC and that its suppression by PSK might represent a useful application of immuno-therapy as part of a program of integrated medicine. AIM: To investigate the possible role of polysaccharide-K (PSK) -lated markers in predicting distant metastasis and in the clinical outcome of colorectal cancer (CRC). METHODS: Firstly, we used protein microarrays to analyze the in vitro expression profiles of potential PSK-related markers in the human colorectal adenocarcinoma cell line SW480, which carries a mutant p53 gene. Then, we investigated the clinical implications of these markers in the prognosis of CRC patients. RESULTS: ECA39, a direct target of c-Myc, was Identi-fied as a candidate protein affected by the anti-metastat- ic effects of PSK. Immunohistochemistry revealed that ECA39 was expressed at significantly higher levels in tumor tissues with distant metastases than those without (P <0.00001). Positive ECA39 expression was shown to be highly reliable for the prediction of distant metastases (sensitivity: 86.7%, specificity: 90%, posi-tive predictive value: 86.7%, negative predictive value: 90%). higher cumulative 5-yr disease was observed in the ECA39-positive patient group (77.3%) compared with the ECA39-positive patient group (25.8%). CONCLUSION: Our results suggest that ECA39 is a dominant predictive factor for distant metastasis in pa-tients with advanced CRC and that its suppression by PSK might represent a useful application of immuno-therapy as part of a program of integrated medicine.