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目的:探讨甲状腺乳头状癌患者上纵隔淋巴结转移的危险因素。方法:选取2013年12月至2015年12月就诊于中国医学科学院肿瘤医院、超声诊断为临床淋巴结阳性(cN1，包括cN1a和cN1b)的248例初治甲状腺癌患者进行前瞻性队列研究。所有患者术前均行颈胸增强CT检查，对可疑上纵隔淋巴结转移的患者术中行可疑区域淋巴结清扫。依据术后病理结果将患者分为上纵隔淋巴结转移组和无上纵隔淋巴结转移组。生存分析采用Kaplan-Meier法，多因素分析采用logistic回归分析。结果:248例患者中，术后病理提示上纵隔淋巴结转移54例；术后病理分期为T1期86例，T2期94例，T3期17例，T4期51例；N1a期21例，N1b期227例，上纵隔淋巴结转移组与无上纵隔淋巴结转移组患者的T分期和N分期差异有统计学意义(均n P2 cm、超声肿瘤双侧、CT双颈淋巴结转移、甲状腺球蛋白(Tg)升高、抗甲状腺球蛋白抗体(ATG)升高均与上纵隔淋巴结转移有关(均n P10枚、Ⅵ区转移淋巴结数目>3枚、Ⅵ区转移淋巴结数目>6枚、Ⅵ区转移淋巴结占总清扫淋巴结比例>1/2、Ⅳ区淋巴结转移数目>5枚、Ⅳ区转移淋巴结占总清扫淋巴结比例>1/3均与上纵隔淋巴结转移有关(均n P1/2、Ⅳ区转移淋巴结占总清扫淋巴结比例>1/3均为上纵隔淋巴结转移的独立危险因素(均n P3 and >6, the proportion of metastatic lymph nodes in level Ⅵ>1/2, the number of metastatic lymph nodes in level Ⅳ> 5 and metastatic proportion >1/3 are risk factors for metastasis of upper mediastinal lymph node(alln P1/2, and in level Ⅳ>1/3 are independent risk factors for upper mediastinum lymph node metastasis(alln P<0.05). The 5-year recurrence-free survival rates of the upper mediastinal lymph node metastasis group and the no upper mediastinal lymph node metastasis group were 92.3% and 94.8% respectively, and the difference was not statistically significant(n P=0.307).n Conclusions:For preoperative ultrasound considering the presence of lymph node metastases, enhanced neck to thorax CT should be performed routinely. When bilateral cervical lymph node metastasis is determined by CT, or endocrine tests suggest abnormally increased antibodies, attention should be paid to the upper mediastinal lymph nodes metastasis. In the course of neck dissection, if more lymph node metastases in level Ⅵ and level Ⅳ were detected, surgeons should be vigilant of the upper mediastinal metastasis. The prognosis of patients underwent complete mediastinal dissection is not significantly different from that of patients without mediastinal metastasis.