Publication:

Preoperative neutrophil-to-lymphocyte ratio as a prognostic indicator in papillary thyroid carcinoma: a retrospective analysis of 123 patients

Background Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy with an excellent prognosis, yet a subset of patients exhibits aggressive disease. This study aimed to evaluate the prognostic significance of the preoperative neutrophil-to-lymphocyte ratio (NLR) in PTC patients at Benha University Hospital, Egypt.

Methods A retrospective cohort study was conducted on 123 patients who underwent total thyroidectomy for PTC between January 2014 and December 2023. The preoperative NLR was calculated from complete blood counts. An optimal cut-off value was determined using receiver operating characteristic (ROC) curve analysis. Patients were stratified into low-NLR and high-NLR groups. Associations between NLR and clinicopathological parameters and recurrence-free survival (RFS) were analyzed.

Results The optimal NLR cut-off was 2.4. The high-NLR group (NLR ≥2.4, n=48) demonstrated significantly higher rates of aggressive features compared to the low-NLR group (NLR<2.4, n=75), including larger tumor size (2.1±1.1 cm versus 1.5±0.7 cm, p=0.001), extrathyroidal extension (52.1% versus 20.0%, p<0.001), lymphovascular invasion (29.2% versus 10.7%, p=0.008), central lymph node metastasis (58.3% versus 26.7%, p<0.001), and advanced AJCC stage III/IV (47.9% versus 14.7%, p<0.001). Multivariate analysis confirmed high NLR as an independent predictor for extrathyroidal extension (OR: 3.41, 95% CI: 1.54-7.55, p=0.002) and lymph node metastasis (OR: 3.85, 95% CI: 1.75-8.48, p=0.001). Kaplan-Meier analysis revealed significantly worse 5-year RFS in the high-NLR group (83.1%) versus the low-NLR group (97.1%) (log-rank p<0.001).

Conclusions A preoperative NLR≥2.4 is a strong, independent prognostic marker associated with aggressive tumor characteristics and significantly worse recurrence-free survival in PTC. Its integration into preoperative assessment can enhance risk stratification.