Abstract： Objective To explore the pattern of lymph node metastasis(LNM)in advanced proximal gastric cancer in order to guide lymphadenectomy.Methods Between September 2001 and December 2005.a total of 103 patients with advanced proximal gastric cancer underwent radical gastrectomy with D2 or>D2 lymphadenectomy.The clinical characteristics,pathologic features, and LNM were analyzed by univariate and multivariate analysis. esults LNM was observed in 81 of 103 cases(78.6%).The LNM was identified in 70.8% at N1,38.3% at N2,22.3% at N3.LNM frequency was found in groups No.3,No.1,No.2 and No.4Sa,4Sb(from the highest to the lowest)at N1,groups No.7,No.10,No.9,No.11,No.8a and No.4d at N2,and groups No.5,No.6,No.16 and No.12 at N3.Ordinal Logistic regression analysis showed that histopathological type,tumor size,depth of invasion,and distant metastasis were independent factors for lymph node metastasis in advanced proximal gastric cancer.Conclusions The number of lymph node metastasis in advanced proximal gastric cancer is mainly associated with differentiation,tumor size,depth,of invasion,and distant metastasis.It is essential to dissect the lymph nodes according to the risk of lymph node metastasis.