目的·探究肾脏累及的弥漫性大B细胞淋巴瘤（diffuse large B-cell lymphoma，DLBCL）患者的临床病理特征，包括临床基本信息、病理特征、基因突变谱与预后相关因素等。方法·回顾性分析2005年7月—2021年11月上海交通大学医学院附属瑞金医院收治的149例肾脏累及的DLBCL患者的临床资料，包括治疗方案、疗效评价及分期等，并采用靶向测序（54个淋巴瘤相关基因）评估患者的基因突变情况。基于患者资料进行生存和预后因素分析。结果·在149例DLBCL肾脏累及的患者中，有87例患者（58.4%）年龄>60岁，121例患者（81.2%）Ann Arbor分期为Ⅲ~Ⅳ期，27例患者（18.1%）美国东部肿瘤协作组评分≥2分，121例患者（81.2%）血清乳酸脱氢酶（lactate dehydrogenase，LDH）高于正常上限，111例患者（74.5%）至少存在2个以上淋巴结外器官受累，131例患者（87.9%）国际预后指数≥2分。患者的5年总生存率和5年无进展生存率分别为52.2%和50.4%。在病理特征中，145例患者（97.3%）诊断为非特指型DLBCL。按Hans分型，39例患者（26.2%）属生发中心亚型。在可评估疗效的144例患者中，87例（60.4%）患者取得完全缓解。此外，单因素分析显示：血清LDH升高是肾脏累及的DLBCL患者总体生存时间（P=0.048）和无进展生存时间（P=0.033）的不良预后因素；75例肾脏累及的DLBCL患者的靶向测序显示PIM1（n=23，31%）、MYD88（n=22，29%）、CD79B（n=21，28%）和KMT2D（n=18，24%）存在高频突变，其中CD79B突变与较差的总体生存时间相关（P=0.034）。结论·肾脏累及的DLBCL患者临床特征中血清LDH升高与不良预后有关，基因突变谱中CD79B突变与不良预后有关。

Objective ·To analyze the clinicopathologic characteristics of patients with kidney-involved diffuse large B-cell lymphoma (DLBCL), including clinical characteristics, pathological characteristics, gene mutation profiles, and prognostic factors. Methods ·One hundred and forty-nine patients with kidney-involved DLBCL, admitted to Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from July 2005 to November 2021, were retrospectively analyzed for their clinicopathological data, survival and prognostic factors, which included therapeutic methods, clinical outcomes, staging, etc. Gene mutation profiles were evaluated by targeted sequencing of 54 lymphoma-related genes. Prognostic factors were also analyzed based on the information mentioned above. Results ·A total of 149 kidney-involved DLBCL cases were included, of which 89 patients (58.4%) were aged over sixty, 121 patients (81.2%) were staged Ann Arbor Ⅲ?Ⅳ, 27 patients (18.1%) had an Eastern Cooperative Oncology Group (ECOG) performance status of two or more, 121 patients (81.2%) had elevated serum lactate dehydrogenase (LDH) level, 111 patients (74.5%) had extranodal invasion in at least two organs and 131 patients (87.9%) scored over 2 points on the international prognosis index (IPI). The estimated 5-year overall survival (OS) rate and progression-free survival (PFS) rate of kidney-involved DLBCL patients were 52.2% and 50.4% respectively. Univariate analysis revealed that elevated serum LDH levels were an adverse prognostic factor for both OS (P=0.048) and PFS (P=0.033). In pathological characteristics, 145 patients (97.3%) belonged to DLBCL, not otherwise specified (NOS) and 39 patients (26.3%) belonged to germinal center B-cell (GCB) according to Hans classification. Among 144 patients who could be evaluated for clinical outcomes, 87 patients (60.4%) got complete response (CR). Targeted sequencing data from 75 kidney-involved DLBCL patients showed high mutation frequency in PIM1 (n=23, 31%), MYD88 (n=22, 29%), CD79B (n=21, 28%) and KMT2D (n=18, 24%), with CD79B mutation indentified as an adverse prognostic factor for OS in patients with kidney-involved DLBCL (P=0.034). Conclusion ·Elevated serum LDH level is an adverse prognostic factor in patients with kidney-involved DLBCL. The prognosis of patients with CD79B mutations is poor.