Cervical lymph node metastasis is a common feature of papillary thyroid cancer (PTC) and is estimated to develop in 30% to 80% of patients with PTC.1 The association of cervical nodal metastasis with overall survival is a subject of ongoing investigation. The lymph node ratio (LNR) is the ratio of disease-positive nodes to total nodes harvested during a neck dissection. Our study investigates the association of LNR with overall survival in patients with PTC.