Background: We aimed to determine whether the use of pulmonary nodule diameter and CTR predicts lymph nodes (LNs) metastasis for early-stage (cT1N0M0) lung adenocarcinoma. Methods: We retrospectively analyzed 433 consecutive patients who underwent therapeutic surgical resection in our hospital. Information about age, sex, history of malignancy, smoking index, high-resolution computed tomography (HRCT) imaging information, pathologic findings, and status of LNs metastasis were collected. Results: A total of 433 patients were included 277 women and 156 men, with a median age of 58.09 +/- 9.41 years. On univariate and multivariate analysis, visceral pleural invasion (VPI) (P=0.005), the diameter of nodule measured by postoperative pathology (DP) (P=0.011), the largest axial diameter of the lesion on the mediastinal window (DM) (P<0.001), the ratio of the maximum diameter of consolidation relative to the maximum tumor diameter from the lung window (CTR) (P=0.01), and total dissected LNs number (P=0.005) categories were independent facto for LNs metastasis. The receiver operating characteristic (ROC) curve showed that DM >= 11.81 cm, or CTR >= 79.50%, or VPI indicated LNs metastasis. LNs metastasis patients could be better predicted by a total dissected LNs number with a cutoff point of 13.5 for lung cancer. Conclusions: VPI, DP, DM, CTR, and total dissected LNs number categories were independent factors for LNs metastasis. If DM >= 11.81 cm, or CTR >= 79.50%, or VPI systemic lymphadenectomy was recommended. We suggested 14 LNs as the cut point for the evaluation LNs examination.