Abstract: Objective To explore the clinical features of cN0 patients with papillary thyroid microcarcinoma(PTMC) and the risk factors of central lymph node metastasis in cN0 patients PTMC, and whether preoperative NLR can be used as one of the indicators to predict central lymph node metastasis of PTMC. Methods The clinical and pathological data of 120 cN0 patients with PTMC admitted to the Department of Oncology, the First Affiliated Hospital of Bengbu Medical College from January 2018 to December 2018 were retrospectively analyzed. The clinical characteristics of cN0 patients with PTMC and the risk factors of central lymph node metastasis were analyzed. The ROC curve was used to predict the effect of preoperative NLR on central lymph node metastasis, and the relationship between preoperative NLR and clinicopathology of PTMC and the relationship between preoperative NLR and tumor size were analyzed. Results In 120 cN0 patients with PTMC, 51(42.5%) central lymph node metastases was occurred. Univariate analysis showed the tumor size, capsule invasion, multifocality, preoperative NLR and preoperative PLR were related to central lymph node metastasis(all P<0.05), but not related to gender, age and primary tumor location(all P>0.05). Multivariate analysis found that the tumor size, multifocality, capsule invasion and preoperative NLR were the risk factors for central lymph node metastasis of cN0 patients with PTMC. Univariate analysis showed preoperative NLR was related to tumor size(P<0.05), but not related to gender, age, primary tumor location, multifocality and capsule invasion(all P>0.05). Spearman's correlation coefficient for ranked data showed preoperative NLR related to tumor size(r=0.434, P<0.001). Conclusion The central lymph node metastasis of cN0 patients with PTMC is related to many factors. For patients with these high-risk factors, prophylactic central node lymph node dissection should be performed. NLR can predict the central lymph node metastasis of cN0 patients with PTMC, which is related to the tumor size.