Distant metastasis also was related to strong CTSK expression (15 cases, 65.2% of carcinomas demonstrated strong CTSK expression), presence of recurrence during follow-up (16 cases, 94.1% of cases that had recurrence), large-sized tumors (17 cases, 65.4% of T3 and T4 tumors), positive nodal involvement (16 cases, 61.5% of nodal positive cases), all the dead cases (5 cases, 100% of deaths), advanced TNM clinical stage (17 cases, 53.1% of stage III and IV cases) (P values were < 0.05). This evidence concerns the gene CTSK and carcinoma.