Abstract: Objective To evaluate the predictive value of thrombus molecular markers thrombin- antithrombin complex ( TAT )，a2-plasmin inhibitor-plasmin complex( PIC)，thrombomodulin( TM) and tssue plasminogen activ ator-plasminogen activator inhibitor-1 complex (t-PAIC) for the efficacy of chemotherapy in patients with advanced non-small cell lung cancer ( NSCLC). Methods The plasma levels of TAT, PIC, TM and t-PAIC before chemotherapy in 117 patients with advanced NSCLC ( 102 patients with lung adeno-carcinoma and 15 patients with lung squamous cell carcinoma) from August 2019 to June 2021 in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. According to the efficacy of chemotherapy, the patients were divided into 2 groups: disease control group (83 cases) and disease progression group ( 34 cases). The plasma TAT, PIC, TM, t-PAIC levels were compared with the healthy control group (94 cases). The control of disease after two cycles of chemotherapy was regarded as the standard. The receiver operating characteristic ( ROC) curves were used to evaluate the diagnostie efficacy of the change rate of thrombus molecular marker levels before and after chemotherapy for disease progression. Univariate and multivariate analysis were used to assess the influencing factors of chemothenapy efficacy in the patients with advanced NSCLC. Results The levels of TAT, PIC, TM and t-PAIC in plasma of NSCLC group were higher than those in healthy control group ( all P<0.05). The levels of TAT, PIC, TM and t-PAIC in disease prpgression group were higher than those in disease control group and halthy control group ( all P<0.05). The levels of TAT, PIC, TM and t-PAIC in disease contol group were higher than those in healthy control group ( all P<0.05). In single detection, the area under ROC curve ( AUCROC ) of the change rate of TAT for diagnosis of disease progression was the largest, followed by PIC, TM and t-PAIC. The AUCROC of combined detection of TAT, PIC, TM and t-PAIC was 0.824 ( sensitivity: 82. 4%，specificity:72.3% ). The results of univariate analysis showed that the ratios ofTAT, PIC, TM, t-PAIC before and after chemotherapy were the in- fluencing factors of chemotherapy efficacy in the patients with advanced NSCLC ( P<0.05). In multivariate analysis, the ratio of TAT before and after chemotherapy>1.09, ratio of PIC before and after chemotherapy>1.09, ratio of TM before and after chemotherapy>1.03, and ratio of tPAIC before and after chemotherapy> 1.00 showed as the independent risk factors infuencing the efficacy of chemo- therapy in advanced NSCLC. Conclusion The coagulation function is imbalanced in patients with advanced NSCLC. The thrombus molecular markers should have significant clinical value for evaluating the efficacy of chemotherapy.