摘要目的:探讨老年弥漫大B细胞淋巴瘤患者的临床疗效及影响预后的相关因素。方法:回顾性分析2015年1月至2019年12月复旦大学附属华东医院收治的76例老年（≥60岁）弥漫大B细胞淋巴瘤患者的临床资料。首选R-CHOP方案治疗54例，其余患者因年龄、身体状况、经济因素等原因选择R-miniCHOP、CHOP等方案或支持治疗，未列入疗效分析。采用Kaplan-Meier法分析患者生存情况。采用多因素Cox比例风险模型分析预后相关因素。结果:首选R-CHOP方案治疗的54例患者中，完全缓解26例（48.1%），部分缓解14例（25.9%），总有效率为74.1%（40/54）；其中，37例60~69岁患者总有效率为70.3%（26/37），17例70~79岁患者总有效率为82.4%（14/17），两组间总有效率差异无统计学意义（ χ2=3.01， P=0.390）。76例患者随访1~60个月，至末次随访，49例（64.5%）死亡，中位总生存（OS）时间为16个月，5年OS率为35.5%。Kaplan-Meier法分析显示，初诊年龄≥70岁、美国东部肿瘤协作组（ECOG）评分≥2分、存在B症状、国际预后指数（IPI）评分>3分、乳酸脱氢酶升高、免疫组织化学bcl-2阳性、非生发中心型与不良OS有关（均 P<0.05）。多因素Cox回归分析显示，初诊年龄≥70岁、存在B症状、bcl-2阳性、非生发中心型为OS独立危险因素（均 P<0.05）。 结论:老年弥漫大B细胞淋巴瘤患者生存不佳，初诊高龄、有B症状、bcl-2阳性、非生发中心型是预后的独立危险因素。

abstractsObjective:To investigate the clinical efficacy of elderly patients with diffuse large B-cell lymphoma (DLBCL) and the influencing factors of prognosis.Methods:The clinical data of 76 elderly (≥60 years old) patients with DLBCL admitted to Huadong Hospital Affiliated to Fudan University between January 2015 and December 2019 were retrospectively analyzed. The R-CHOP regimen was the preferred treatment for 54 patients, while the remaining patients received R-miniCHOP, CHOP or other regimens or supportive treatments due to age, physical condition, economic factors, etc., which were not included in the efficacy analysis. Kaplan-Meier method was used to analyze the survival status of patients. Multivariate Cox proportional risk model was used to analyze the prognostic factors.Results:Among the 54 patients who preferred R-CHOP regimen for treatment, 26 cases (48.1%) achieved complete remission and 14 cases (25.9%) achieved partial remission, and the total effective rate was 74.1% (40/54); Among them, the total effective rate of 37 cases aged 60-69 years was 70.3% (26/37), and the total effective rate of 17 cases aged 70-79 years was 82.4% (14/17); there was no statistically significant difference in the total effective rate between the two groups ( χ2 = 3.01, P = 0.390). All 76 patients were followed up for 1-60 months. As of the last follow-up, 49 patients (64.5%) died, with the median overall survival (OS) time of 16 months and 5-year OS rate of 35.5%. Kaplan-Meier method showed that age ≥ 70 years old at initial diagnosis, Eastern Cooperative Oncology Group (ECOG) score ≥ 2 points, presence of B symptoms, international prognosis index (IPI) score >3 points, elevated lactate dehydrogenase, immunohistochemistry positive for bcl-2, and non-germinal center type were associated with poor OS (all P < 0.05). Multivariate Cox analysis showed that age ≥ 70 years old at initial diagnosis, presence of B symptoms, positive expression of bcl-2, non-germinal center type were independent risk factors for OS (all P < 0.05). Conclusions:Elderly DLBCL patients have poor survival. Old age at initial diagnosis, B symptoms, bcl-2 positive, and non-germinal center type are independent risk factors of prognosis.