According to the prediction for the risk of No. 10 LN metastasis, in a previous study, we demonstrated that prediction systems, including factors, such as the tumor infiltration depth and tumor transverse position, with No. 7 and No. 11 LN metastasis provide a better evaluation of No. 10 LN metastasis . However, the guidelines for the preoperative significance are not strong considering the postoperative parameters. This study constructed a TNS scoring system to predict No. 10 LN metastasis and classify patients into three categories: low, intermediate, and high risk. This scoring system identified a high-risk group, which has a 12.3-fold greater risk of No. 10 LN metastasis than the lowest-risk group, and this difference was statistically significant. Further analysis indicated that the area under the ROC curve was 0.820 for the simplified TNS score, with a discriminant ability similar to the logistic regression model, and in the validation group, there was no statistical significance between the observed and predicted incidence rates of No. 10 LN metastasis for the TNS scoring system. In the present study, we evaluated the related factors as preoperative readily available parameters for the simple and effective prediction of the risk of No. 10 LN metastasis and the preoperative discrimination of high-risk groups prone to transfer from low-risk groups, which has important significance for improving the prognosis of patients with upper GC by performing more corresponding, positive and effective targeted operation schemes. Therefore, in combination with the results of the present study, we propose that SHLND is not necessary for low-risk patients, whereas high-risk patients require regular treatments through SHLND. For patients with moderate risk, showing a 13.9% risk of No. 10 LN metastasis, we recommend SHLND to obtain a better radical cure effect (Figure 4).