World Journal of Surgery

, Volume 38, Issue 10, pp 2605–2612 | Cite as

Does Preoperative Neutrophil Lymphocyte Ratio Predict Risk of Recurrence and Occult Central Nodal Metastasis in Papillary Thyroid Carcinoma?

  • Brian Hung-Hin Lang
  • Cathy Po-Ching Ng
  • Kin Bun Au
  • Kai Pun Wong
  • Kandy K. C. Wong
  • Koon Yat Wan



Preoperative neutrophil to lymphocyte ratio (NLR) might be prognostic in papillary thyroid carcinoma (PTC). Given the controversy of prophylactic central neck dissection (pCND) in clinically nodal-negative (cN0) PTC, our study evaluated whether preoperative NLR predicted disease-free survival (DFS) and occult central nodal metastasis (CNM) in cN0 PTC.


A total of 191 patients who underwent pCND were analyzed. Complete blood counts with differential counts were taken before operation. NLR was calculated by dividing preoperative neutrophil count with lymphocyte count. Patients were categorized into NLR tertiles: first (NLR < 1.93; n = 63), second (NLR = 1.93–2.79; n = 64), and third tertile (NLR > 2.79; n = 64). Four other patient types, namely, benign nodular goiter, clinically nodal-positive (cN1) PTC, poorly differentiated thyroid carcinoma, and anaplastic thyroid carcinoma (ATC), were used as references.


Age at operation (p < 0.001) and tumor size (p = 0.037) significantly increased with higher NLR. First tertile had significantly more TNM stage I tumors (p = 0.01) and lowest MACIS score (p = 0.002). Tumor size [hazard ratio (HR) 1.422, 95% confidence interval (CI) 1.119–1.809, p = 0.004] and multicentricity (HR = 2.545, 95% CI 1.073–6.024, p = 0.034) independently predicted DFS, whereas old age [odds ratio (OR) 1.026, 95% CI 1.006–1.046, p = 0.009), male (OR 2.882, 95% CI 1.348–6.172, p = 0.006), and large tumor (OR 1.567, 95% CI 1.209–2.032, p = 0.001) independently predicted occult CNM. NLR was not significantly associated with DFS or occult CNM. ATC had significantly higher NLR than cN1 PTC (7.28 vs. 2.74, p < 0.001).


Although a higher NLR may imply a poorer tumor profile, it was not significantly associated with a worse DFS or higher risk of occult CNM in cN0 PTC. Perhaps, future research should focus on the prognostic value in other thyroid cancer types with a poorer prognosis.


Papillary Thyroid Carcinoma Differentiate Thyroid Carcinoma Anaplastic Thyroid Carcinoma Extrathyroidal Extension Central Nodal Metastasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Brian Hung-Hin Lang
    • 1
    • 3
  • Cathy Po-Ching Ng
    • 1
  • Kin Bun Au
    • 1
  • Kai Pun Wong
    • 1
    • 3
  • Kandy K. C. Wong
    • 1
  • Koon Yat Wan
    • 2
  1. 1.Department of SurgeryThe University of Hong KongHong Kong SARChina
  2. 2.Department of Clinical OncologyThe University of Hong KongHong Kong SARChina
  3. 3.Division of Endocrine Surgery, Department of SurgeryQueen Mary HospitalHong Kong SARChina

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