Abstract: Background　Malignant tumors are one of the major diseases threatening the health of the elderly, and there is relatively little research on the overall disease spectrum of the elderly population both domestically and internationally. Objective　 To analyze the disease spectrum and comorbidities of hospitalized elderly patients (≥60 years) with malignant tumors, offering insights for optimizing cancer prevention and treatment strategies in this population. Methods　The medical record homepage data of elderly (≥60 years) malignant tumor inpatients were collected from 8 tertiary Grade-A hospitals affiliated to Chinese PLA General Hospital from January 2014 to December 2023. Primary diagnoses were statistically analyzed using International Classification of Diseases (ICD-10) codes to examine the disease spectrum composition, gender differences, regional distribution, and comorbidity characteristics. Results　 A total of 230 243 patients were included. Malignant tumors of the digestive organs (43.1%) and respiratory system (22.6%) accounted for the highest proportions, showing significant gender differences (sex ratio for digestive system tumors ranged from 3.2:1 to 3.8:1). The age group of 70 - 80 years had the highest incidence, and lymphatic/hematopoietic system tumors had the highest fatality rate (3.8%). A decade-long trend analysis revealed a significant rise in the ranking of prostate cancer (from 13th to 7th). Regional distribution showed that the proportions of liver and intrahepatic bile duct cancers in the Northeast (25.56%) and Central-South regions (22.69%) both exceeded the national average (16.3%), while bronchus and lung malignancies ranked first in the North China region (21.74%). Cost-mortality analysis indicated a significant positive correlation between breast malignancies and mortality (r=0.39, P<0.05). The comorbidity burden increased sharply with age—among patients aged 80 years and older, 70% had five or more comorbidities, and 30% had eight or more. Conclusion　Malignant tumors in the elderly are predominantly those of the digestive and respiratory systems, with variations in terms of gender, age, and region, and the phenomenon of multiple comorbidities is prominent. Different regions need to strengthen screening for high-risk diseases, optimize the diagnosis and treatment pathways for diseases with cost-mortality rates, and establish a multidisciplinary comorbidity management model.