We conducted a retrospective analysis to evaluate the Musshoff staging system for high-grade primary gastric lymphoma (HG-PGL), particularly in those patients with stages IE and IIE localized diseases. One hundred twenty-six patients presented with stage IE or IIE diseases were retrospectively reclassified on the basis of a pretreatment CT examination as to whether there was lymph node involvement. A positive M1 node (by AJCC staging system) on pretreatment CT scanning was associated with poor clinical outcome for localized stage I or II patients.