Simple SummaryIn a retrospective study, researchers analyzed data from 909 patients with papillary thyroid carcinoma (PTC) who underwent thyroidectomy and neck dissection. The aim was to validate the relationship between lymph node ratio (LNR) and recurrence in patients with fewer than six lymph nodes examined after surgery. Over an average follow-up of 127.24 ± 33.6 months, recurrences occurred in 5.1% of the patients. The analysis identified an LNR ≥ 0.29 as an independent prognostic factor for recurrence. This means that patients with an LNR equal to or higher than 0.29 had a higher likelihood of recurrence compared to those with a lower LNR. These findings highlight the importance of considering LNR as a valuable prognostic marker for PTC patients with limited lymph node examination. Incorporating LNR into risk assessment can improve recurrence prediction and help guide treatment strategies. However, further prospective studies are needed to validate these results and determine their clinical implications in managing PTC patients.AbstractThe American Thyroid Association risk stratification system suggests that having >5 metastatic lymph nodes (LNs) increase the recurrence risk in patients with papillary thyroid carcinoma (PTC). However, little is known about PTC with <5 harvested LNs. This study aimed to stratify patients with low-LN-yield (low-LNY) PTC based on lymph node ratios (LNRs). From 2007 to 2017, 6317 patients who underwent thyroidectomies were diagnosed with PTC at Seoul St. Mary’s Hospital, and 909 patients with low LNYs were included in the study. Tumor recurrence was compared based on LNR. The LNR cutoff was determined using a receiver operating characteristic curve. Forty-six patients (5.1%) experienced recurrences over a mean follow-up period of 127.24 ± 33.6 months (range, 5–190 months). The cutoff for the low-LNR (n= 675) and high-LNR (n= 234) groups was 0.29 (AUC = 0.676, 95% CI = 0.591–0.761,p< 0.001). The recurrence rate was significantly higher in the high-LNR group compared to the rate in the low-LNR group (12.4% vs. 2.5%,p< 0.001). Multivariate analysis using Cox regression revealed that tumor size and LNR ≥ 0.29 were independent prognostic factors for recurrence. Therefore, LNR can be utilized to stratify the risk of recurrence in patients with low-LNY PTC.