Abstract: ObjectiveTo analyze the prognostic significance of the staging system based on the ratio of metastatic lymph nodes (MLR) in patients with gastric cancer. MethodsWe retrospectively analyzed the clinical data of 238 consecutive patients diagnosed with gastric cancer who underwent curative gastrectomy at our hospital. The lymph node status was classified according to two systems: the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) system and an MLR-based system (MLR0: 0, MLR1: 0.01~0.19, MLR2:≥0.2). Overall survival was examined according to N status and N ratio. Results Overall survival stratified by N status was significantly different in patients with <15 nodes examined compared with those with ≥15 nodes examined. When we stratified by N ratio intervals, there was no significantly difference in overall survival in patients with <15 versus ≥15 nodes examined. On univariate analysis, N ratio and N status was retained as an independent prognostic factor. Conclusion The MLR staging system is a simple and reliable tool to stratify patients with gastric cancer and has a higher prognostic power.