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The impact of extent of pancreatic and venous resection on survival for patients with pancreatic cancer

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Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 389-394页

作者： matteo Serenari Giorgio Ercolani Alessandro Cucchetti matteo Zanello Enrico Prosperi Guido Fallani Michele Masetti Raffaele Lombardi matteo Cescon elio Jovine Department of Medical and Surgical Sciences S.Orsola-Malpighi HospitalAlma Mater Studiorum-University of BolognaBolognaItaly Department of General Surgery Maggiore Hospital-Bologna Local Health DistrictBolognaItaly

Background:Borderline resectable pancreatic cancer may require extended resections in order to achieve tumor-free margins,especially in the case of up-front resections,but it is important to know the limits of surgical therapy in this *** study aimed to investigate the impact of extent of pancreatic and venous resection on short-and long-term outcomes in patients with pancreatic adenocarcinoma(PDAC).Methods:This was a retrospective study from a prospectively maintained database of pancreatic resections for ***-and long-term outcomes were analyzed in patients having borderline resectable PDAC submitted to up-front total pancreatectomy(TP)or pancreaticoduodenectomy(PD)with simultaneous portal vein(PV)and/or superior mesenteric vein(SMV)*** resections were carried out as tangential venous resection(TVR)or segmental venous resection(SVR).Patients were divided into 4 groups:(1)PD+TVR,(2)PD+SVR,(3)TP+TVR,(4)TP+***-and multivariate Cox regression analysis were performed to identify factors associated with ***:Ninety-nine patients were submitted to simultaneous pancreatic and venous resection for *** them,25 were submitted to PD+TVR(25.3%),12 to PD+SVR(12.1%),23 to TP+TVR(23.2%),and 39 to TP+SVR(39.4%).Overall,major morbidity(Clavien-Dindo grade≥IIIA)was 26.3%.Thirty-and 90-day mortality were 3%and 11.1%,*** were no significant differences among groups in terms of short-term *** overall survival of patients submitted to PD+TVR was significantly higher than those to TP+SVR(29.5 vs 7.9 months,P=0.001).Multivariate analysis identified TP(HR=2.11;95%CI:1.31–3.44;P=0.002)and SVR(HR=2.01;95%CI:1.27–3.15;P=0.003)as the only independent prognostic factors for overall ***:Up-front TP associated to SVR was predictive of worse survival in borderline resectable *** treatments in high-risk surgical groups may improve such poor outcomes.

关键词： Pancreatic resection Vascular resection Pancreatic cancer surgery

Reduction of muscle contraction and pain in electroporation-based treatments:An overview

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World Journal of Clinical Oncology 2021年第5期12卷 367-381页

作者： Roberta Fusco elio Di Bernardo Valeria D'Alessio Simona Salati matteo Cadossi Department of Medical Oncology IGEA SpACarpi 41012ModenaItaly

BACKGROUND In the first studies of electrochemotherapy(ECT),small cutaneous metastases were treated and only mild or moderate pain was observed;therefore,pain was not considered a significant *** the procedure began to be applied to larger cutaneous metastases,pain was reported more *** that reason,reduction of both muscle contractions and pain have been investigated over the *** To present an overview of different protocols described in literature that aim to reduce muscle contractions and pain caused by the electroporation(EP)effect in both ECT and irreversible EP *** Thirty-three studies published between January 1999 and November 2020 were *** protocol designs and electrode geometries that reduce patient pain and the number of muscle contractions and their intensity were *** The analysis showed that both high frequency and bipolar/biphasic pulses can be used to reduce pain and muscle contractions in patients who undergo EP ***,adequate electrode design can decrease EP-related ***,needle length,diameter and configuration of the distance between the needles can be optimised so that the muscle volume crossed by the current is reduced as much as ***/biphasic pulses with an inadequate pulse length seem to have a less evident effect on the membrane permeability compared with the standard pulse *** that reason,the number of pulses and the voltage amplitude,as well as the pulse duration and frequency,must be chosen so that the dose of delivered energy guarantees EP *** Pain reduction in EP-based treatments can be achieved by appropriately defining the protocol parameters and electrode *** results can be achieved with high frequency and/or bipolar/biphasic ***,the efficacy of these alternative protocols remains a crucial point to be assessed further.

关键词： Electrochemotherapy Irreversible electroporation Pain Muscle contraction Monopolar or monophasic pulses Bipolar or biphasic pulses

Development and internal validation of the Comprehensive ALPPS Preoperative Risk Assessment(CAPRA)score:is the patient suitable for Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)?

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Hepatobiliary Surgery and Nutrition 2022年第1期11卷 52-66,I0007,I0008页

作者： Ivan Capobianco Karl J.Oldhafer Mohammed-Hossein Fard-Aghaie Ricardo Robles-Campos Roberto Brusadin Henrik Petrowsky Michael Linecker Arianeb Mehrabi Katrin Hoffmann Jun Li Asmus Heumann Roberto Hernandez-Alejandro Mauro Enrique Tun-Abraham elio Jovine matteo Serenari Bergthor Bjornsson Per Sandström Ruslan Alikhanov Mikhail Efanov Paolo Muiesan Andrea Schlegel Thomas M.van Gulik Pim B.Olthof Gregor Alexander Stavrou Lina Maria Serna-Higuita Alfred Königsrainer Silvio Nadalin Department of General Visceral and Transplant SurgeryUniversity Hospital TübingenTübingenGermany Department of General and Abdominal Surgery Asklepios Hospital BarmbekHamburgGermany Department of Surgery Virgen de la Arrixaca Clinic and University HospitalMurciaSpain Swiss HPB and Transplantation Center Department of SurgeryZurich University HospitalZurichSwitzerland Department of General Visceraland Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany General Visceral and Thoracic Surgery Department and ClinicHamburg-Eppendorf University Medical CenterHamburgGermany Division of Transplantation and Hepatobiliary Surgery University of RochesterRochesterNYUSA Division of HPB Surgery and Liver Transplantation Department of SurgeryLondon Health Sciences CentreLondonCanada General and Emergency Surgery Unit Azienda Ospedaliero-Universitaria di BolognaMaggiore HospitalBolognaItaly General Surgery and Transplantation Unit Azienda Ospedaliero-Universitaria di BolognaSant’Orsola-Malpighi HospitalBolognaItaly Department of Surgery in Linköping and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden Department of Hepatopancreatobiliary Surgery Moscow Clinical Scientific CenterMoscowRussia Liver Unit Queen Elizabeth Hospital BirminghamUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK Department of Surgery Amsterdam UMC(Location AMC)University of AmsterdamAmsterdamThe Netherlands Department of General Abdominal and Thoracic SurgerySurgical OncologySaarbruecken General HospitalSaarbrueckenGermany Department of Clinical Epidemiology and Applied Biometry University of TübingenTübingenGermany

Background:Preoperative patient selection in Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS)is not always reliable with currently available scores,particularly in patients with primary liver *** study aims to(I)to determine whether comorbidities and patients characteristics are a risk factor in ALPPS and(II)to create a score predicting 90-day mortality ***:Thirteen high-volume centers participated in this retrospective multicentric study.A risk analysis based on patient characteristics,underlying disease and procedure type was performed to identify risk factors and model the Comprehensive ALPPS Preoperative Risk Assessment(CAPRA)score.A nonparametric receiver operating characteristic analysis was performed to estimate the predictive ability of our score against the Charlson Comorbidity Index(CCI),the age-adjusted CCI(aCCI),the ALPPS risk score before Stage 1(ALPPS-RS1)and Stage 2(ALPPS-RS2).The model was internally validated applying ***:A total of 451 patients were *** was 14.4%.The CAPRA score is calculated based on the following formula:(0.1×age)−(2×BSA)+1(in the presence of primary liver tumor)+1(in the presence of severe cardiovascular disease)+2(in the presence of moderate or severe diabetes)+2(in the presence of renal disease)+2(if classic ALPPS is planned).The predictive ability was 0.837 for the CAPRA score,0.443 for CCI,0.519 for aCCI,0.693 for ALPPS-RS1 and 0.807 for *** 1,000 cycles of bootstrapping the C statistic was *** accuracy plot revealed a cut-off for optimal prediction of postoperative mortality of ***:Comorbidities play an important role in ALPPS and should be carefully considered when planning the *** assessing the patient’s preoperative condition in relation to ALPPS,the CAPRA score has a very good ability to predict postoperative mortality.

关键词： Associating Liver Partition and Portal vein ligation for Staged hepatectomy(ALPPS) comorbidity mortality prediction model patient selection

Advances in laparoscopy for acute care surgery and trauma

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World Journal of Gastroenterology 2016年第2期22卷 668-680页

作者： matteo Mandrioli Kenji Inaba Alice Piccinini Andrea Biscardi Massimo Sartelli Ferdinando Agresta Fausto Catena Roberto Cirocchi elio Jovine Gregorio Tugnoli Salomone Di Saverio Department of Emergency and General Surgery and Trauma Surgery Unit C.A.Pizzardi Maggiore Hospital Trauma Center40133 BolognaItaly Division of Trauma Surgery and Surgical Critical Care Department of SurgeryUniversity of Southern CaliforniaLos AngelesCA 90033United States Department of Surgery Macerata Hospital62100 MacerataItaly Department of Surgery Adria Hospital45011 AdriaRovigoItaly Department of Emergency and Trauma Surgery Maggiore Hospital43126 ParmaItaly Departement of Digestive Surgery and Liver Unit St.Maria Hospital05100 TerniPerugiaItaly

The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers,for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a la

关键词： Laparoscopy Acute care surgery Singleincisionlaparoscopic surgery Natural orifice transluminalendoscopic surgery Trauma

Prognostic criteria for postoperative mortality in 170 patients undergoing major right hepatectomy

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Hepatobiliary & Pancreatic Diseases International 2012年第5期11卷 507-512页

作者： Filippo Filicori Xavier M Keutgen matteo Zanello Giorgio Ercolani Salomone Di Saverio Federico Sacchetti Antonio Daniele Pinna Gian Luca Grazi General Surgery and Transplant Unit Department of General Surgery and Organ TransplantationUniversity of BolognaVia Massarenti 940138 BolognaItaly Department of Surgery New York Presbyterian Hospital Weill Cornell Medical College Department of Surgery New York Presbyterian HospitalWeill Cornell Medical College Department of Emergency Surgery Maggiore HospitalL.go Nigrisoli 240133 BolognaItaly Hepato-Biliary Surgery Unit Istituto Nazionale Tumori Regina ElenaVia Elio Chianesi5300144 RomaItaly

BACKGROUND: Postoperative hepatic failure is a dreadful complication after major hepatectomy and carries high morbidity and mortality rates. In this study, we assessed the accuracy of the 50/50 criteria (bilirubin >2.9 mg/dL and international normalized ratio >1.7 on postoperative day 5) and the Mullen criteria (bilirubin peak >7 mg/dL on postoperative days 1-7) in predicting death from hepatic failure in patients undergoing right hepatectomy only. In addition, we identified prognostic factors linked to intra-hospital morbidity and mortality in these patients. METHODS: One hundred seventy consecutive patients underwent major right hepatectomy at a tertiary medical center from 2000 to 2008. Nineteen (11.2%) patients suffered from liver cirrhosis. Univariate and multivariate analyses were performed to identify predictors of intra-hospital mortality, morbidity and death from hepatic failure. RESULTS: The intra-hospital mortality was 6.5% (11/170). Of the six patients who died from hepatic failure, one was positive for the 50/50 criteria, but all six patients were positive for the Mullen criteria. Multivariate analysis showed that male gender, hepatitis C (HCV), hepatocellular carcinoma, postoperative bilirubin >7 mg/dL and ALT65 years, HCV, reoperation, andrenal failure were significant predictors of overall intra-hospital mortality on multivariate analysis. CONCLUSIONS: The Mullen criteria were more accurate than the 50/50 criteria in predicting death from hepatic failure in patients undergoing right hepatectomy. A bilirubin peak >7 mg/dL in the postoperative period, HCV positivity, hepatocellular carcinoma, and an ALT level <188 U/L on postoperative day 1 were associated with death from hepatic failure in our patient population.

关键词： hepatectomy liver diseases liver failure postoperative complications prothrombin time bilirubin

Possible association between hepatitis C virus and malignancies different from hepatocellular carcinoma:A systematic review

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World Journal of Gastroenterology 2015年第45期21卷 12896-12953页

作者： Sirio Fiorino Letizia Bacchi-Reggiani Dario de Biase Adele Fornelli Michele Masetti Andrea Tura Fabio Grizzi matteo Zanello Laura Mastrangelo Raffaele Lombardi Giorgia Acquaviva Luca di Tommaso Arrigo Bondi Michela Visani Sergio Sabbatani Laura Pontoriero Carlo Fabbri Andrea Cuppini Annalisa Pession elio Jovine Unità Operativa di Medicina Interna Ospedale di Budrio Dipartimento di Medicina Sperimentale Istituto di Cardiologia Policlinico S. Orsola-Malpighi Università degli Studi di Bologna Dipartimento di Medicina Sperimentale Università di Bologna Unità Operativa Biologia Molecolare Anatomia Patologica Ospedale Bellaria Servizio di Anatomia Patologica Ospedale Maggiore Unità Operativa di Chirurgia A Ospedale Maggiore Institute of Neuroscience National Research Council Humanitas Clinical and Research Center Rozzano Dipartimento di Farmacia e Biotecnologie Università di Bologna Istituto di Malattie Infettive Policlinico S. Orsola-Malpighi Università degli Studi di Bologna Unità di Cura Materno-Infantile Distretto Lametino U.O. Endoscopia Ospedale Maggiore

AIM: To summarize the current knowledge about the potential relationship between hepatitis C virus(HCV) infection and the risk of several extra-liver cancers. METHODS: We performed a systematic review of the literature, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis(PRISMA) Statement. We extracted the pertinent articles, published in MEDLINE and the Cochrane Library, using the following search terms: neoplasm/cancer/malignancy/tumor/carcinoma/adeno-carcinoma and non-Hodgkin lymphomas, kidney/renal-, cholangio-, pancreatic-, thyroid-, breast-,oral-, skin-, prostate-, lung-, colon-, stomach-, haematologic. Case series, case-series with control-group, case-control, cohort-studies as well as meta-analyses, written in English were collected. Some of the main characteristics of retrieved trials, which were designed to investigate the prevalence of HCV infection in each type of the above-mentioned human malignancies were summarised. A main table was defined and included a short description in the text for each of these tumours, whether at least five studies about a specific neoplasm, meeting inclusion criteria, were available in literature. According to these criteria, we created the following sections and the corresponding tables and we indicated the number of included or excluded articles, as well as of meta-analyses and reviews:(1) HCV and haematopoietic malignancies;(2) HCV and cholangiocarcinoma;(3) HCV and pancreatic cancer;(4) HCV and breast cancer;(5) HCV and kidney cancer;(6) HCV and skin or oral cancer; and(7) HCV and thyroid cancer. RESULTS: According to available data, a clear correlation between regions of HCV prevalence and risk of extra-liver cancers has emerged only for a very small group of types and histological subtypes of malignancies. In particular, HCV infection has been associated with:(1) a higher incidence of some B-cell Non-HodgkinLymphoma types, in countries, where an elevated prevalence of this pathogen is de

关键词： Neoplasm Cancer Hepatitis C virus Risk factors Ext

MicroRNAs as possible biomarkers for diagnosis and prognosis of hepatitis b- and c-related-hepatocellularcarcinoma

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World Journal of Gastroenterology 2016年第15期22卷 3907-3936页

作者： Sirio Fiorino Maria Letizia Bacchi-Reggiani Michela Visani Giorgia Acquaviva Adele Fornelli Michele Masetti Andrea Tura Fabio Grizzi matteo Zanello Laura Mastrangelo Raffaele Lombardi Luca Di Tommaso Arrigo Bondi Sergio Sabbatani Andrea Domanico Carlo Fabbri Paolo Leandri Annalisa Pession elio Jovine Dario de Biase Unita Operativa di Medicina C Ospedale Maggiore 40133 Bologna Italy Dipartimento di Medicina Sperimentale Istituto di Cardiologia Policlinico S. Orsola-Malpighi Universita degli Studi di Bologna 40138 BolognaItaly Dipartimento di Farmacia e Biotecnologie Universita di Bologna 40139 Bologna Italy Dipartimento di Medicina Sperimentale Universita di Bologna Ospedale Bellaria 40139 Bologna Italy Servizio di Anatomia Patologica Ospedale Maggiore 40133 Bologna Italy Unita Operativa di Chirurgia A Ospedale Maggiore 40133 Bologna Italy CNR Institute of Neuroscience Padova Italy 35121 Padova Italy Humanitas Clinical and Research Center 20089 Rozzano Milano Italy Istituto di Malattie Infettive Policlinico S. Orsola-Malpighi Universita degli Studi di Bologna 40138 Bologna Italy Unita Operativa di Medicina Interna A Ospedale Maggiore 40133 Bologna Italy Unita Operativa di Endoscopia Digestiva Ospedale Maggiore 40133 Bologna Italy

Aim of the present review is to summarize the current knowledge about the potential relationship between mi RNAs and hepatitis B virus(HBV)-hepatitis C virus(HCV) related liver diseases. A systematic computerbased search of published articles, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis Statement, was performed to identify relevant studies on usefulness of serum/plasma/urine mi RNAs, as noninvasive biomarkers for early detection of HBV and HCV-induced hepatocellular carcinoma(HCC) development, as well as for its prognostic evaluation. The used Medical Subject Headings terms and keywords were: "HBV", "HCV", "hepatocellular carcinoma", "micro RNAs", "mi RNAs", "diagnosis", "prognosis", "therapy", "treatment". Some serum/plasma mi RNAs, including mi R-21, mi R-122, mi-125a/b, mi R-199a/b, mi R-221, mi R-222, mi R-223, mi R-224 might serve as biomarkers for early diagnosis/prognosis of HCC, but, to date, not definitive results or well-defined panels of mi RNAs have been obtained. More well-designed studies, focusing on populations of different geographical areas and involving larger series of patients, should be carried out to improve our knowledge on the potential role of mi RNAs for HCC early detection and prognosis.

关键词： Hepatitis B virus Hepatitis C virus Hepatocellular carcinomas Liver diseases MicroRNAs Review

Boceprevir or telaprevir in hepatitis C virus chronic infection:The Italian real life experience

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World Journal of Hepatology 2016年第22期8卷 949-956页

作者： Antonio Ascione Luigi elio Adinolfi Pietro Amoroso Angelo Andriulli Orlando Armignacco Tiziana Ascione Sergio Babudieri Giorgio Barbarini Michele Brogna Francesco Cesario Vincenzo Citro Ernesto Claar Raffaele Cozzolongo Giuseppe D’Adamo Emilio D’Amico Pellegrino Dattolo Massimo De Luca Vincenzo De Maria Massimo De Siena Giuseppe De Vita Antonio Di Giacomo Rosanna De Marco Giorgio De Stefano Giulio De Stefano Sebastiano Di Salvo Raffaele Di Sarno Nunzia Farella Laura Felicioni Basilio Fimiani Luca Fontanella Giuseppe Foti Caterina Furlan Francesca Giancotti Giancarlo Giolitto Tiziana Gravina Barbara Guerrera Roberto Gulminetti Angelo Iacobellis Michele Imparato Angelo Iodice Vincenzo Iovinella Antonio Izzi Alfonso Liberti Pietro Leo Gennaro Lettieri Ileana Luppino Aldo Marrone Ettore Mazzoni Vincenzo Messina Roberto Monarca Vincenzo Narciso Lorenzo Nosotti Adriano Maria Pellicelli Alessandro Perrella Guido Piai Antonio Picardi Paola Pierri Grazia Pietromatera Francesco Resta Luca Rinaldi Mario Romano Angelo Rossini Maurizio Russello Grazia Russo Rodolfo Sacco Vincenzo Sangiovanni Antonio Schiano Antonio Sciambra Gaetano Scifo Filomena Simeone Annarita Sullo Pierluigi Tarquini Paolo Tundo Alfredo Vallone Depart-ment of Medicine Center for Liver Diseases "Buon Consiglio" -Fatebenefratelli Hospital Internal Medicine Unit Second University of Naples VI Division of Infectious Diseases Cotugno Hospital AORN "Ospedali dei Colli" Division of Gastro- enterology Casa Sollievo Sofferenza Hospital IRCCS Division of Infectious Diseases Belcolle Hospital IX Division of Infectious Diseases Cotugno Hospital AORN "Ospedali dei Colli" Clinical of Infectious Disease University of Sassari Infectious Disease IRCCS San matteo Division of Infectious Diseases and Liver Unit "G. Iazzolino" Hospital Division of Infectious Diseases "Annunziata" Hospital Depart-ment of Internal Medicine Umberto I Hospital Internal Medicine Ospedale Evangelico Villa Betania Division of Gastroenterology IRCCS "S.de Bellis" Hospital Internal Medicine Unit Pescara-Penne Hospital Gastroenterology Unit Marcianise Hospital Liver Unit AORN Cardarelli Liver Unit Policlinico "Mater Domini" Service of Medical Day Hospital "Rummo" Hospital Internal Medicine Regina Margherita Hospital Division of Gastroenterology "Annunziata" Hospital Infectious Disease Matera Hospital First Division of Infectious Diseases Cotugno Hospital AORN "Ospedali dei Colli" Division of Infectious Diseases AO Melacrino- Bianchi-Morelli Infectious and Tropical Disease Policlinico Umberto I Division of Infectious Disease Maria SS Addolorata Hospital Division of Infectious Diseases S. Anna and S. Sebastiano Hospital Outpatients Service for Liver Diseases "Loreto Crispi" Hospital V Division of Infectious Diseases Cotugno Hospital AORN "Ospedali dei Colli" Department of Medical Surgical Neurological Geriatric and Metabolic Sciences Second Univer-sity of Naples Liver Unit Policlinico Casilino Medicine and Health Unit for Prisoners Belcolle Hospital Internal Medicine Unit "Ascalesi" Hospital Gastrointestinal and Liver Department National Institute for Health Migration and Poverty Liver Unit Azienda Ospedaliera San Camillo Forlanini VII Division of Infectious Diseases

AIM: To check the safety and efficacy of boceprevir/telaprevir with peginterferon/ribavirin for hepatitis C virus(HCV) genotype 1 in the real-world settings. METHODS: This study was a non-randomized, observational, prospective, multicenter. This study involved 47 centers in Italy. A database was prepared for the homogenous collection of the data, was used by all of the centers for data collection, and was updated continuously. All of the patients enrolled in this study were older than 18 years of age and were diagnosed with chronic infection due to HCV genotype 1. The HCV RNA testing was performed using COBAS-Taq Man2.0(Roche, LLQ 25 IU/m L). RESULTS: All consecutively treated patients were included. Forty-seven centers enrolled 834 patients as follows: Male 64%; median age 57(range 18-78), of whom 18.3% were over 65; mean body mass index 25.6(range 16-39); genotype 1b(79.4%); diagnosis of cirrhosis(38.2%); and fibrosis F3/4(71.2%). The following drugs were used: Telaprevir(66.2%) and PEG-IFN-alpha2a(67.6%). Patients were na?ve(24.4%), relapsers(30.5%), partial responders(14.8%) and null responders(30.3%). Overall, adverse events(AEs) occurred in 617 patients(73.9%) during the treatment. Anemia was the most frequent AE(52.9% of cases), especially in cirrhotic. The therapy was stopped for 14.6% of the patients because of adverse events or virological failure(15%). Sustained virological response was achieved in 62.7% of the cases, but was 43.8% in cirrhotic patients over 65 years of age. CONCLUSION: In everyday practice, triple therapy is safe but has moderate efficacy, especially for patients over 65 years of age, with advanced fibrosis, nonresponders to peginterferon + ribavirin.

关键词： Boceprevir Telaprevir Chronic hepatitis Antiviral therapy Peg-interferon Ribavirin