Abstract: Objective: To compare the efficacy and safety between bevacizumab combined with chemotherapy(BAP) and sintilimab combined with chemotherapy(SAP) in the first-line treatment of patients with sensitive driver mutation-negative lung adenocarcinoma. Methods: The clinical data of sensitive driver mutation-negative lung adenocarcinoma patients who received first-line treatment from 2021 to 2023 were retrospectively collected,and the differences in the short-term efficacy,long-term efficacy,and incidence of adverse reactions between BAP and SAP regimens were analyzed. Results: There was no statistical significance in the ORR and DCR between two groups(P>0.05).The median progression-free survival(mPFS) of total population was 7.97 months.The mPFS of patients with liver metastasis was significantly worse than that of patients without liver metastasis(P<0.05).The mPFS of patients with ≥2 metastatic organs was worse than that of patients with <2 metastatic organs(P<0.01).The results of subgroup analysis showed that the mPFS of patients treated with BAP regimen was 7.50 months,and the mPFS of patients treated with SAP regimen was 8.13 months.The mPFS of liver metastasis patients treated with BAP was 4.03 months,while that of the SAP group was 1.67 months,and the difference was statistically significant(P<0.05).Among patients with CNS metastasis and/or liver metastasis,the mPFS in the BAP group was superior to that in SAP group(P<0.05).Among the patients with ≥2 metastatic organs,there was no statistical significance in the mPFS between the BAP and SAP groups(P>0.05). Conclusions: In the first-line treatment of advanced lung adenocarcinoma with negative sensitive driver mutation,the clinical efficacy of the BAP and SAP regimens is similar.However,in the visceral metastasis subgroup of CNS metastasis and/or liver metastasis,the patients in the BAP group may benefit more.