ABSTRACT: Objective This study was to analyze the risk factors of level Ⅶ lymph node metastasis for patients with papillary thyroid carcinoma(PTC)(cN_1b). Methods 134 cases of papillary thyroid carcinoma(cN_1b)who underwent level Ⅱ-Ⅶ lymph node dissection were analyzed retrospectively. Clinical and pathologic data were collected from patients who were first diagnosed as papillary thyroid carcinoma. Chi-square test and multivariate logistic regression analysis were used to identify the risk factors of the level Ⅶ lymph node metastasis. Results The Ⅶ lymph node metastasis rate of PTC patients was 53%. Univariate analysis indicated that tumor T staging(P<0.001,χ²=31.897), level Ⅵ lymph node metastasis(P<0.001,χ²=17.743), and lateral lymph node metastasis(P=0.032,χ²=4.773)were significantly correlated with level Ⅶ lymph node metastasis. Multivariate logistic regression analysis indicated that tumor T staging(P=0.001)and level Ⅵ lymph node metastasis(P=0.018)independently correlated with level Ⅶ lymph node metastasis. Conclusion The(cN_1b)PTC has a high rate of pathological lymph node metastasis, It is important to conduct the level Ⅶ lymph node dissection for the PTC(cN_1b)patients with the risk factors.