Objective It is still unclear whether the clinicopathological and outcome characteristics of vascular invasion (VI) (+) papillary thyroid carcinoma (PTC) differ from VI (−) PTC. This study aims to establish distinguishing features of patients with VI (+) and VI (−) PTC and to investigate the biological and clinical aggressiveness of the disease in these patient groups.

Design A matched-case comparative study.

Methods 412 patients (VI (+) PTC study group n=103, and VI (−) PTC control group n=309). These two patient groups were matched 1:3 for variables of age, gender, histological variants, tumour/node/metastasis (TNM) staging and approximate duration of follow-up. Clinicopathological factors and prognosis were compared across the two patient groups.

Results The median age at the time of diagnosis was 42.0 years, and 68.9% were females. Across the patient groups, the incidence of tumour multifocality in patients with VI (+) PTC was slightly higher than in those with VI (−) PTC (p=0.049). In addition, when undergoing more aggressive therapy regimens patients with VI (+) PTC showed decreased distant recurrence-free survival (DRFS), but not regional recurrence-free survival (RRFS) and disease-specific survival (DSS) compared with patients who were VI (−). VI was found to be an independent predictor of DRFS, combined with tumour size >3 cm and total thyroidectomy.

Conclusions VI was an independent risk factor for DRFS, necessitating the need for appropriate postoperative treatment and careful follow-up.