Objective：To evaluate and analyze the risk factors associated with tracheal lymph node metastasis in patients with papillary thyroid carcinoma（PTC），as well as the predictive ability of pretracheal lymph node involvement for tracheal lymph node metastasis. Methods：A retrospective analysis was conducted on the data of 645 patients who underwent surgical treatment for PTC in our hospital. According to the surgical indications and resection scope recommended in the Chinese Thyroid Cancer Diagnosis and Treatment Guidelines（2022 edition），thyroidectomy and lymph node dissection were performed based on preoperative palpation， ultrasound examination，and fine-needle aspiration biopsy results. Results：Among the 645 cases，215 cases（33.3%）were pathologically confirmed to have tracheal lymph node metastasis after surgery. Univariate analysis suggested that tracheal lymph node metastasis was associated with age <45 years，maximum tumor diameter ≥1 cm，intraglandular spread，extraglandular invasion， multifocal lesions，involvement of both lobes，and pretracheal lymph node metastasis. Multivariate analysis indicated that age <45 years and pretracheal lymph node metastasis were independent risk factors for tracheal lymph node metastasis. The sensitivity，specificity， positive predictive value，negative predictive value，and accuracy of pretracheal lymph node involvement in predicting tracheal lymph node metastasis were 21.4%，93.7%，63.0%，70.5%，and 69.6%，respectively. Conclusion：In young patients with PTC and pretracheal lymph node metastasis，careful evaluation of tracheal lymph node status is necessary. Pretracheal lymph node involvement has a certain predictive role in tracheal lymph node metastasis. Assessing pretracheal lymph nodes can help formulate strategies for managing tracheal lymph nodes，but more evidence from evidence-based medicine is still needed to facilitate better decision-making.