Qian Xiaohan, Fu Mengjiao, Zheng Jing, Chen Junjun, Cai Cuihong, Zhou Jianya, Zhou Jianying
Department of Respiratory Disease, Thoracic Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Thorac Cancer. 2025 Aug;16(15):e70141. doi: 10.1111/1759-7714.70141.
Previous studies have reported inconsistent findings regarding the associationbetween ALK and ROS1 rearrangements in lung cancer and thromboembolic risk. This retrospective study aimed to investigate this association in advanced lung adenocarcinoma patients with ALK, ROS1, RET rearrangements, and EGFR mutations.
We retrospectively collected information on patients with advanced lung adenocarcinoma in the First Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to March 2021. All patients with confirmed ALK, ROS1, or RET rearrangements, as well as a comparison cohort of those with EGFR mutation, were included. Clinical characteristics were analyzed, and the association between driver genes and TE risks was analyzed using competing risk and logistic regression.
A total of 546 patients were included in the study. Among them, those with ROS1 rearrangements exhibited the highest cumulative incidence of thromboembolic events (TEs), reaching 17.5% ± 0.2% during the peri-diagnostic period (within 6 months following diagnosis). Regardless of the entire follow-up or the peri-diagnostic period, ROS1 rearrangements were significantly associated with an increased risk of TEs. Multivariate analysis revealed ROS1 rearrangements, the number of comorbidities, the size of mediastinal lymph nodes, and elevated C-reactive protein (CRP) levels as TE risk factors during the peri-diagnostic period. Throughout the follow-up period, ROS1 rearrangements and hypertension were independent TE risk factors. In addition, the development of TE significantly affected the overall survival of patients with EGFR mutations.
ROS1 rearrangements were significantly associated with an increased risk of TE.
既往研究报道了肺癌中ALK与ROS1重排和血栓栓塞风险之间的关联，但结果并不一致。本回顾性研究旨在调查晚期肺腺癌患者中ALK、ROS1、RET重排及EGFR突变与血栓栓塞风险之间的关联。
我们回顾性收集了2013年1月至2021年3月浙江大学医学院附属第一医院晚期肺腺癌患者的信息。纳入所有确诊为ALK、ROS1或RET重排的患者，以及EGFR突变患者作为对照队列。分析临床特征，并使用竞争风险和逻辑回归分析驱动基因与血栓栓塞风险之间的关联。
本研究共纳入546例患者。其中，ROS1重排患者在诊断周围期（诊断后6个月内）血栓栓塞事件（TEs）的累积发生率最高，达17.5%±0.2%。无论整个随访期还是诊断周围期，ROS1重排均与TEs风险增加显著相关。多因素分析显示，诊断周围期ROS1重排、合并症数量、纵隔淋巴结大小及C反应蛋白（CRP）水平升高是TEs的危险因素。在整个随访期，ROS1重排和高血压是独立的TEs危险因素。此外，TEs的发生显著影响EGFR突变患者的总生存期。
ROS1重排与TEs风险增加显著相关。
