目的 分析c-ROS癌基因1融合阳性肺腺癌患者的临床特征.方法 选取2014年3月至2017年1月在浙江大学医学院附属第一医院进行基因检测的1 482例肺腺癌患者,根据基因突变的不同分为ROS1融合阳性组、渐变淋巴瘤激酶(anaplastic lymphoma kinase,ALK)融合阳性组、表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变组及3个基因突变均阴性组.另收集2017年2-12月确诊的20例ROS1阳性患者纳入ROS1阳性组.收集并比较ROS1融合阳性组与其余驱动基因突变组间患者的年龄、性别、吸烟史、肿瘤TNM分期、驱动基因突变、胸部CT等临床特征,连续变量比较采用Mann-Whitney检验,分类变量比较采用x2检验.结果 ROS1融合阳性患者共54例,其中男19例,女35例.ALK融合阳性患者共73例,男28例,女45例.EGFR基因突变患者共679例,男293例,女386例.3个基因突变均阴性的患者共676例.ROS1融合阳性组平均发病年龄为(54±12)岁,小于EGFR基因突变组的(60±11)岁,差异有统计学意义(z=-3.982,P＜0.001),亦小于3个基因突变均阴性组的(62±10)岁,差异有统计学意义(z=-4.944,P＜0.001);ROS1融合阳性组女性患者比例(64.8％,35/54)显著高于3个基因突变均阴性的肺腺癌组(28.4％,192/676),差异有统计学意义(x2=30.94,P＜0.001);ROS1融合阳性组不吸烟患者比例(72.2％,39/54)显著高于3个基因突变均阴性肺腺癌组(38.0％,257/676),差异有统计学意义(x2=24.27,P＜0.001);ROS1融合和ALK融合阳性肺腺癌患者的性别、年龄、吸烟史均无统计学相关性,各型驱动基因突变腺癌亚型之间TNM分期无统计学差异.ROS1融合阳性肺腺癌在胸部CT上以周围型肺癌表现为主(71.4％,20/28),多为实性密度影(75％,21/28),其中分叶状(75.0％,21/28)和细毛刺(57.1％,16/28)是ROS1融合阳性肺腺癌的常见征象.结论 c-ROS癌基因1融合在肺腺癌患者中发生率低,多见于年轻不吸烟女性患者,可以与EGFR基因突变共存.“,”Objective To study the prevalence of c-ros oncogene 1 fusion in lung adenocarcinoma and to evaluate its relationship with clinical characteristics.Methods We retrospectively analyzed epidermal growth factor receptor (EGFR) mutation,anaplastic lymphoma kinase (ALK) and c-ros oncogene 1 (ROS1) fusion in 1 482 patients with adenocarcinoma from March 2014 to January 2017 in the first affiliated hospital of Zhejiang University.Furthermore,ROS1 fusion positive patients diagnosed between February 2017 and December 2017 were also included in ROS1 positive group.The data of age,sex,smoking history,TNM stage and chest computed tomography were collected by Electronic Medical Record (EMR).The clinical data were compared by the chi-squared test or Mann-Whitney test.Results Of these 1 482 patients,54 cases were diagnosed with ROS1 rearrangement,including 19 males and 35 females,while 73 cases were diagnosed with ALK rearrangement,including 28 males and 45 females,and 679 cases diagnosed with EGFR mutation including 293 males and 386 females.And there were 676 patients without driven genes mutation.The mean age in ROS1 fusion group(54± 12)was lower than EGFR mutation group (60± 11,z=-3.982,P＜0.001) and WT group (62± 10,z=-4.944,P＜0.001).Female proportion in ROS1 fusion group (64.8％,35/54) was higher than WT group (28.4％,192/676,x2=30.94,P＜0.001).Non-smoker percentages in ROS1 fusion group (72.2％,39/54) was significantly higher than WT group (38.0％,257/676,x2=24.27,P＜ 0.001).ROS1 fusion group was similar to ALK fusion group in sex,age and smoking history,and there were no significant difference in TNM stage among these groups.On chest CT,adenocarcinomas with ROS1 fusion were found to be more peripheral in location (71.4％,20/28) and solid in density (75％,21/28),usually with lobulated margins (75.0％,21/28) and spiculated in contour (57.1％,16/28).Conclusion In our study lung adenocarcinoma with c-ROS oncogene 1 fusion was a rare subtype lung cancer and was usually detected in young,never smoking,and female patients.