To explore the predictive value of combined detection of BRAF^V600E, platelet-to-albumin ratio (PAR) and fibrinogen-to-prealbumin ratio (FPR) for central lymph node metastasis in clinically node-negative (cN0) papillary thyroid carcinoma (PTC).

The clinical data of 196 patients with cN0 PTC admitted from January 2022 to December 2024 were retrospectively analyzed. Patients were divided into the metastasis group (n=57) and non-metastasis group (n=139) according to the presence or absence of postoperative central lymph node metastasis. Clinical data, BRAF^V600E status, PAR and FPR were compared between the two groups. Statistical analysis was performed using SPSS software version 28.0, Binary Logistic regression analysis was performed to identify influencing factors for central lymph node metastasis in cN0 PTC. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of BRAF^V600E mutation abundance, PAR and FPR for central lymph node metastasis of cN0 PTC.

The metastasis group showed significantly higher male proportion, maximum tumor diameter, BRAF^V600E mutation abundance, platelet count (PLT), PAR, fibrinogen (FIB) and FPR than the non-metastasis group (P<0.05). Meanwhile, age, proportion of left-sided tumors, albumin (ALB) and prealbumin (PAB) levels were markedly lower in the metastasis group (P<0.05). Male gender, age, maximum tumor diameter, BRAF^V600E mutation abundance, PAR and FPR were independent risk factors for central lymph node metastasis in cN0 PTC (odds ratio OR=1.287, 0.523, 1.164, 1.984, 2.265, 1.724, all (P<0.05). The combined panel of BRAF^V600E mutation abundance, PAR and FPR achieved superior predictive efficacy for central lymph node metastasis in cN0 PTC, with an area under the curve (AUC) of 0.897 (P<0.05).

BRAF^V600E mutation abundance, PAR and FPR are all correlated with central lymph node metastasis in cN0 PTC. Preoperative combined detection of these three indicators exhibits favorable predictive value for central lymph node metastasis.