Background: The aims of this study were to identify the clinical significances of the size of metastatic lymph node\n(mLN) and LN ratio (LNR) and to attempt to create a risk stratification for papillary thyroid carcinoma (PTC) patients.\nMethods: We investigated the 435 PTC patients who underwent radioactive iodine (RAI) ablation treatment\nfollowing thyroid surgery. The patients were classified into two groups (micrometastasis (pN1mic) � 0.2 cm and\nmacrometastasis (pN1mac) > 0.2 cm) and were stratified into the following three risk groups: group I (pN1mic,\nLNR � 0.5); group II (pN1mic, LNR > 0.5 or pN1mac, LNR � 0.5); and group III (pN1mac with LNR > 0.5). And then we\ninvestigated the association of the classified groups and variable clinicopathologic factors.\nResults: The clinical characteristics such as large tumor size, extrathyroidal extension, higher T stage, and greater\nnumber of mLN or LNR were significantly associated with pN1mac. The mean stimulated thyroglobulin levels were\nincreased with the patient risk groups (p = 0.02). The recurrence-free survivals were significantly different between\nthe stratified groups (p = 0.001).\nConclusions: The patient groups I, II, and III may be referred to as low-, intermediate-, and high-risk groups.\nClinicians should consider the possibility of recurrence, and the decisions about the application of RAI ablation\nbased on the size of mLN and the patient�s risk groups
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