Abstract:Objective To systematically review the incidence of venous thromboembolism (VTE) in patients with non-small-cell lung cancer (NSCLC) by different driver gene mutations, and to further explore the associations of driver gene mutation status with the risk of VTE in patients with NSCLC.Methods A complete search of PubMed, EMbase, Web of Science, Cochrane Library, CNKI, Wanfang and VIP Database were performed to obtain eligible studies on the relationship between driver gene mutation status and the risk of VTE published to 3rd July 2023. Statistical analysis was performed using Stata 14.0 software. Results A total of 32 studies were included, with an overall sample size of 18032 cases. The meta-analysis results indicated that the overall incidence of VTE in lung cancer patients with driver gene mutations was 19%［95%CI(15%-23%)］; the incidence of VTE complications was highest at 31%［95%CI(22%-39%)］ in patients with ROS1 gene fusion. The presence of anaplastic lymphoma kinase (ALK)/ROS1 gene fusion/rearrangement and positive programmed death-ligand 1 (PD-L1) expression was associated with an increased risk of VTE ［ALK: OR=2.28,95%CI(1.89-2.76); ROS1: OR=3.18,95%CI(1.89-5.35); PD-L1: OR=1.85,95%CI (1.25-2.72)］, while epidermal growth factor receptor（EGFR）/kirsten rat sarcoma viral oncogene (KRAS) gene mutations showed no significant correlation with the risk of VTE ［EGFR:OR=1.16,95%CI(0.75-1.80); KRAS: OR=1.54,95%CI(0.98-2.43)］. Conclusion There are significant differences in the incidence of VTE complications related to NSCLC under different driver gene mutation statuses. The presence of ALK/ROS1 gene fusion/rearrangement and positive PD-L1 expression is associated with an increased risk of VTE, whereas EGFR/KRAS gene mutations do not show a significant correlation with VTE risk.