Objective: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.