BACKGROUND: Gastric cancer (GC) poses a significant threat to public health. However, the clinicopathological features and tumor biological behaviors vary among the GC patients, leading to individual variations in lymph node metastasis. Consequently, the stratification of lymph node dissection according to the specific type, particularly upper GC, has emerged as a prominent area of research. AIM: To investigate the distribution of metastatic lymph nodes in patients with upper and lower GC and to analyze the differences in related pathological elements and prognosis. METHODS: Differential analysis between upper and lower GC patients with various clinicopathological factors was performed using the chi-square test and rank-sum test. Logistic regression models were used to identify risk factors for GC lymph node metastasis, while Cox regression models were used to analyze risk factors affecting patient prognosis. The Kaplan-Meier method was used to construct survival curves associated with prognostic risk factors for GC. RESULTS: Significant differences were observed between the two GC populations regarding tumor diameter, histological grade, pT stage, pN stage, tumor-node-metastasis (pTNM) stage, vascular invasion, and adjuvant chemotherapy usage (all CONCLUSION: Upper GC showed a significantly higher malignancy grade and different lymph node metastasis pattern than lower GC.