Background: Adenocarcinoma of the oesophagogastric junction (AEG) potentially metastasizes to lymph nodes (LNs) in the abdomen and thorax. The aim of this study was to analyse the impact of metastatic LN location on prognosis in patients with AEG. Methods: From May 2000 to March 2002, 645 patients with AEG underwent resection in our hospital. There were 525 males and 120 females, aged from 31 to 78 years (median = 60 years). Follow-up was carried out by correspondence every 6 months. N-classification according to the number (0, 1-2, 3-6, > 6; N0-3), station (0, 1, 2, 3; S0-3) or field (0, 1 (abdominal or mediastinal), 2 (abdominal and mediastinal); F0-2) of LN metastasis and other prognostic factors were evaluated by univariate and multivariate survival analyses. Results: Of the 645 patients, 307 (47.6%) had LN metastasis. The 5-year survival rate for patients with LN metastases was 16.0% compared to 36.8% for those without LN metastases (P = 0.000). The length of tumour, and the number, station and field of the LN metastasis were independent prognostic factors by multivariate analysis. However, when patients without LN metastasis were excluded from the survival analysis by log-rank test, there were significant differences only in patients with F1 versus F2 LN metastasis, with 5-year survival rates of 14.4% and 8.0%, respectively (P = 0.022). Conclusion: The presence of LN metastases concurrently in both the abdomen and mediastinum is a significant adverse prognostic factor for patients with AEG, and should be included in the future TNM staging system.