Deciphering nodal burden in thyroid carcinoma: A dedicated survey of age, lymph node ratio, log odds of positive nodes, and preoperative prediction models

Abstract Evidence regarding the prognosis of thyroid carcinoma is heterogeneous, ranging from age effects and nodal burden metrics, such as lymph node ratio (LNR) and log odds of positive nodes (LODDS), to preoperative imaging models comprising ultrasound, CEUS, and radiomics. We conducted a systematic review in line with PRISMA 2020 and SWiM, tabulated under four domains: age relative to the American Joint Committee on Cancer (AJCC‐8) staging system, LNR and LODDS, and preoperative prediction models. Terminology and units were standardized through dual data extraction and Python‐based harmonization. Prognostic studies were evaluated by Quality in Prognosis Studies, and prediction models were assessed using PROBAST. The AJCC‐8 55‐year threshold remains pragmatically useful, yet continuous nonlinear modeling of age offers better support for individualized risk estimates. Supplementing anatomic N staging with LNR significantly enhances prognostication, with compartment‐specific ratios refining the N1 subgroup. LODDS should be coreported with LNR because it is less sensitive to lymph‐node yield, preserves information at extreme values, and often equals or outperforms LNR. Preoperative radiomics and nomograms are promising but often lack external validation and adequate calibration, limiting clinical readiness. Common limitations include endpoint heterogeneity, variable follow‐up, node‐yield dependency, and sparse reporting of calibration or decision‐curve analysis. Residual confounding in retrospective cohorts and reporting bias remain significant challenges.