Background: thymidine phosphorylase (TP) has been identified as a specific marker enzyme that is expressed in tumor-infiltrating macrophages, being associated with tumor angiogenesis and poor prognosis in patients with intestinal-type gastric cancer. However, the clinical and prognostic significance of TP expression in gastric cancer remains controversial. Publications were identified which assessed the clinical or prognostic significance of TP expression in gastric cancer from January 1995 to May 2013. A meta-analysis was performed to clarify the association between TP expression and clinical outcomes. A total of 13 studies met the inclusion criteria, and comprised 1541 cases. Analysis of these data showed that there was no statistically significant association of TP and tumor differentiation (pooled OR = 0.88, 95% CI: 0.67–1.15, Z = 0.94, P = 0.95, fixed-effect). There was significant association between the expression of TP and clinical parameters such as lymph node metastasis (pooled OR = 2.35, 95% CI: 1.42–3.88, Z = 3.34, P = 0.0009 random-effect) or lymphatic invasion (pooled OR = 1.71, 95% CI: 1.02–2.87, Z = 2.02, P = 0.04 random-effect).Moreover, in identified studies, the expression of TP was correlated with reduced overall survival (relative risk [RR] = 1.73, 95% CI: 1.06–2.82, Z = 2.19, P = 0.03). TP expression is associated with tumor aggressiveness and poor prognosis. If this finding is confirmed by well-designed prospective studies, TP expression may be a useful prognostic indicator for clinical outcome in patients with gastric cancer.