Objective To investigate the predictors of No.10 lymph nodes metastasis in patients with the advanced gastric cancer. Methods A retrospective study was performed to analyze 142 patients who underwent D2 curative proximal or total gastrectomy for gastric carcinoma from January 2006 to December 2009. Clinicopathological factors and molecular markers such as sex, age, location of the primary tumor, tumor sizes, gross type, depth of invasion, the metastasis of adjacent lymph node, Ki-67, matrix metalloproteinase(MMP)7, and p53 status were analyzed with univariate and multivariate analysis. Results The overall ratio of metastatic lymph node was 66.2% (94/142). The positive rates of No 10 lymph nodes were 16.2%(23/142). The No 10 lymph node metastasis was correlated with tumor site, size, Borrmann type, depth of invasion, and No4s lymph node metastasis but biomarkers Ki-67, MMP7 and p53. Multivariable logistic regression analysis showed that positive metastasis of No.4s lymph node was an independent risk factor for lymph node metastasis in No.10 lymph nodes. The positive rates of No.10 lymph nodes were 7.8% and 26.6% for the No4s lymph nodes negative patients and positive patients, respectively. Conclusion The status of No4s lymph nodes is an independent risk factor of No.10 lymph nodes metastasis in patients with advanced gastric cancer, but the negative predict value is not low enough to 5 percent. We can’t predict negative No.10 lymph nodes accurately in patients with advanced gastric cancer.