Background: The trend of prophylactic neck dissection for clinically nodal-negative papillary thyroid carcinoma (PTC) is still a subject of controversy. Despite the risk of higher morbidities, a more selective approach based on risk factors has been proposed. Systemic inflammation highlights the potential of preoperative neutrophil-to-lymphocyte ratio (NLR) as a convenient biomarker in predicting nodal metastasis. This review aims to evaluate the potential of preoperative NLR in predicting occult nodal metastasis in PTC. Methods: We conducted a systematic literature search across PubMed, ProQuest, Scopus, and Cochrane Library. The protocol of this systematic review had been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42024516033. Results: Eight cohort articles involving 3,434 patients across nations were included. All articles demonstrated an association between higher NLR and nodal metastasis. Four of these studies exhibited significant associations (p<0.05), potentially explained by NLR cut-off values falling between 2 and 2.1. Conclusion: NLR might serve as an excellent biomarker to predict occult nodal metastasis in patients with PTC. Moreover, this study could be a basis of utilizing NLR as an accessible, low-cost adjunct to refine preoperative risk stratification and to help prioritize intensified nodal evaluation in cN0 PTC. Copyright © 2025 Celsius Publishing House www.sgo-iasgo.com