Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC

Autores
Piñero, Federico; Anders, Margarita; Bermudez, Carla; Demirdjian, Ezequiel; Varón, Adriana; Palazzo, Ana; Rodriguez, Jorge; Beltrán, Oscar; Gomes da Fonseca, Leonardo; Ridruejo, Ezequiel; Caballini, Pablo; Tamagnone, Norberto; Reggiardo, María Virginia; Cheinquer, Hugo; Araujo, Alexandre; Arufe, Diego; Marín, Juan Ignacio; Ratusnu, Natalia; Manero, Estela; Perez, Daniela; Villa, Marina; Orozco, Federico; Murga, Dolores; Marciano, Sebastián; Bessone, Fernando; Silva, Marcelo; Mendizabal, Manuel
Año de publicación
2023
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Introduction and Objectives: With the advent of new therapeutic options for patients with hepatocellular carcinoma (HCC) for intermediate or advanced stages of the Barcelona Clinic Liver Cancer (BCLC), regional real-world data regarding prognostic survival factors are of significant importance. Patients and Methods: A multicenter prospective cohort study was conducted in Latin America including BCLC B or C patients since 15th May 2018. We report here the second interim analysis focusing on prognostic variables and causes of treatment discontinuation. Cox proportional hazard survival analysis was performed, estimating hazard ratios (HR) and 95% confidence intervals (95% CI). Results: Overall, 390 patients were included, 55.1% and 44.9% were BCLC B and C at the time of study enrollment. Cirrhosis was present in 89.5% of the cohort. Among the BCLC-B group, 42.3% were treated with TACE with a median survival since the first session of 41.9 months. Liver decompensation before TACE was independently associated with increased mortality [HR 3.22 (CI 1.64;6.33); P<.001]. Systemic treatment was initiated in 48.2% of the cohort (n=188), with a median survival of 15.7 months. Of these, 48.9% presented first-line treatment discontinuation (44.4% tumor progression, 29.3% liver decompensation, 18.5% symptomatic deterioration, and 7.8% intolerance), and only 28.7% received second-line systemic treatments. Liver decompensation [HR 2.9 (1.64;5.29); P<.0001], and symptomatic progression [HR 3.9 (1.53;9.78); P=0.004] were independently associated with mortality after first-line systemic treatment discontinuation. Conclusions: The complexity of these patients, with one-third presenting liver decompensation after systemic therapies, underlines the need for multidisciplinary team management and the central role of hepatologists.
Fil: Piñero, Federico. Universidad Austral. Hospital Universitario Austral; Argentina
Fil: Anders, Margarita. Hospital Alemán; Argentina
Fil: Bermudez, Carla. Hospital Italiano; Argentina
Fil: Demirdjian, Ezequiel. Instituto Médico Sagrado Corazón; Argentina
Fil: Varón, Adriana. Fundación Cardioinfantil. Instituto de Cardiología; Colombia
Fil: Palazzo, Ana. Gobierno de la Provincia de Tucumán. Hospital Ángel Padilla; Argentina
Fil: Rodriguez, Jorge. Hospital San Juan de Dios;
Fil: Beltrán, Oscar. Fundación Cardioinfantil. Instituto de Cardiología; Colombia
Fil: Gomes da Fonseca, Leonardo. Universidade de Sao Paulo; Brasil
Fil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina
Fil: Caballini, Pablo. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina
Fil: Tamagnone, Norberto. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina
Fil: Reggiardo, María Virginia. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina
Fil: Cheinquer, Hugo. Universidade Federal do Rio Grande do Sul; Brasil
Fil: Araujo, Alexandre. Universidade Federal do Rio Grande do Sul; Brasil
Fil: Arufe, Diego. Instituto Médico Sagrado Corazón; Argentina
Fil: Marín, Juan Ignacio. Hospital Pablo Tobon Uribe; Colombia
Fil: Ratusnu, Natalia. Hospital Regional de Ushuaia; Argentina
Fil: Manero, Estela. Hospital Pablo Soria; Argentina
Fil: Perez, Daniela. Gobierno de la Provincia de Tucumán. Hospital Ángel Padilla; Argentina
Fil: Villa, Marina. Hospital Comarcal de Blanes; Argentina
Fil: Orozco, Federico. Hospital Alemán; Argentina
Fil: Murga, Dolores. Gobierno de la Provincia de Tucumán. Hospital Ángel Padilla; Argentina
Fil: Marciano, Sebastián. Hospital Italiano; Argentina
Fil: Bessone, Fernando. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina
Fil: Silva, Marcelo. Universidad Austral. Hospital Universitario Austral; Argentina
Fil: Mendizabal, Manuel. Universidad Austral. Hospital Universitario Austral; Argentina
Materia
LIVER CANCER
OUTCOMES
PROGNOSIS
PROGRESSION
REAL-WORLD
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/229129
Acceder
id CONICETDig_80c0ed44e886406cced8cb5c82fc4e54
oai_identifier_str oai:ri.conicet.gov.ar:11336/229129
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCCPiñero, FedericoAnders, MargaritaBermudez, CarlaDemirdjian, EzequielVarón, AdrianaPalazzo, AnaRodriguez, JorgeBeltrán, OscarGomes da Fonseca, LeonardoRidruejo, EzequielCaballini, PabloTamagnone, NorbertoReggiardo, María VirginiaCheinquer, HugoAraujo, AlexandreArufe, DiegoMarín, Juan IgnacioRatusnu, NataliaManero, EstelaPerez, DanielaVilla, MarinaOrozco, FedericoMurga, DoloresMarciano, SebastiánBessone, FernandoSilva, MarceloMendizabal, ManuelLIVER CANCEROUTCOMESPROGNOSISPROGRESSIONREAL-WORLDhttps://purl.org/becyt/ford/3.2https://purl.org/becyt/ford/3Introduction and Objectives: With the advent of new therapeutic options for patients with hepatocellular carcinoma (HCC) for intermediate or advanced stages of the Barcelona Clinic Liver Cancer (BCLC), regional real-world data regarding prognostic survival factors are of significant importance. Patients and Methods: A multicenter prospective cohort study was conducted in Latin America including BCLC B or C patients since 15th May 2018. We report here the second interim analysis focusing on prognostic variables and causes of treatment discontinuation. Cox proportional hazard survival analysis was performed, estimating hazard ratios (HR) and 95% confidence intervals (95% CI). Results: Overall, 390 patients were included, 55.1% and 44.9% were BCLC B and C at the time of study enrollment. Cirrhosis was present in 89.5% of the cohort. Among the BCLC-B group, 42.3% were treated with TACE with a median survival since the first session of 41.9 months. Liver decompensation before TACE was independently associated with increased mortality [HR 3.22 (CI 1.64;6.33); P<.001]. Systemic treatment was initiated in 48.2% of the cohort (n=188), with a median survival of 15.7 months. Of these, 48.9% presented first-line treatment discontinuation (44.4% tumor progression, 29.3% liver decompensation, 18.5% symptomatic deterioration, and 7.8% intolerance), and only 28.7% received second-line systemic treatments. Liver decompensation [HR 2.9 (1.64;5.29); P<.0001], and symptomatic progression [HR 3.9 (1.53;9.78); P=0.004] were independently associated with mortality after first-line systemic treatment discontinuation. Conclusions: The complexity of these patients, with one-third presenting liver decompensation after systemic therapies, underlines the need for multidisciplinary team management and the central role of hepatologists.Fil: Piñero, Federico. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Anders, Margarita. Hospital Alemán; ArgentinaFil: Bermudez, Carla. Hospital Italiano; ArgentinaFil: Demirdjian, Ezequiel. Instituto Médico Sagrado Corazón; ArgentinaFil: Varón, Adriana. Fundación Cardioinfantil. Instituto de Cardiología; ColombiaFil: Palazzo, Ana. Gobierno de la Provincia de Tucumán. Hospital Ángel Padilla; ArgentinaFil: Rodriguez, Jorge. Hospital San Juan de Dios;Fil: Beltrán, Oscar. Fundación Cardioinfantil. Instituto de Cardiología; ColombiaFil: Gomes da Fonseca, Leonardo. Universidade de Sao Paulo; BrasilFil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Caballini, Pablo. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; ArgentinaFil: Tamagnone, Norberto. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; ArgentinaFil: Reggiardo, María Virginia. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; ArgentinaFil: Cheinquer, Hugo. Universidade Federal do Rio Grande do Sul; BrasilFil: Araujo, Alexandre. Universidade Federal do Rio Grande do Sul; BrasilFil: Arufe, Diego. Instituto Médico Sagrado Corazón; ArgentinaFil: Marín, Juan Ignacio. Hospital Pablo Tobon Uribe; ColombiaFil: Ratusnu, Natalia. Hospital Regional de Ushuaia; ArgentinaFil: Manero, Estela. Hospital Pablo Soria; ArgentinaFil: Perez, Daniela. Gobierno de la Provincia de Tucumán. Hospital Ángel Padilla; ArgentinaFil: Villa, Marina. Hospital Comarcal de Blanes; ArgentinaFil: Orozco, Federico. Hospital Alemán; ArgentinaFil: Murga, Dolores. Gobierno de la Provincia de Tucumán. Hospital Ángel Padilla; ArgentinaFil: Marciano, Sebastián. Hospital Italiano; ArgentinaFil: Bessone, Fernando. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; ArgentinaFil: Silva, Marcelo. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Mendizabal, Manuel. Universidad Austral. Hospital Universitario Austral; ArgentinaMexican Association of Hepatology2023-07info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/229129Piñero, Federico; Anders, Margarita; Bermudez, Carla; Demirdjian, Ezequiel; Varón, Adriana; et al.; Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC; Mexican Association of Hepatology; Annals of Hepatology; 28; 4; 7-2023; 1-71665-2681CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/doi/10.1016/j.aohep.2023.101110info:eu-repo/semantics/altIdentifier/url/https://www.sciencedirect.com/science/article/pii/S1665268123002144info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-nd/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-11-12T09:54:37Zoai:ri.conicet.gov.ar:11336/229129instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-11-12 09:54:38.088CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC
title Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC
spellingShingle Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC
Piñero, Federico
LIVER CANCER
OUTCOMES
PROGNOSIS
PROGRESSION
REAL-WORLD
title_short Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC
title_full Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC
title_fullStr Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC
title_full_unstemmed Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC
title_sort Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC
dc.creator.none.fl_str_mv Piñero, Federico
Anders, Margarita
Bermudez, Carla
Demirdjian, Ezequiel
Varón, Adriana
Palazzo, Ana
Rodriguez, Jorge
Beltrán, Oscar
Gomes da Fonseca, Leonardo
Ridruejo, Ezequiel
Caballini, Pablo
Tamagnone, Norberto
Reggiardo, María Virginia
Cheinquer, Hugo
Araujo, Alexandre
Arufe, Diego
Marín, Juan Ignacio
Ratusnu, Natalia
Manero, Estela
Perez, Daniela
Villa, Marina
Orozco, Federico
Murga, Dolores
Marciano, Sebastián
Bessone, Fernando
Silva, Marcelo
Mendizabal, Manuel
author Piñero, Federico
author_facet Piñero, Federico
Anders, Margarita
Bermudez, Carla
Demirdjian, Ezequiel
Varón, Adriana
Palazzo, Ana
Rodriguez, Jorge
Beltrán, Oscar
Gomes da Fonseca, Leonardo
Ridruejo, Ezequiel
Caballini, Pablo
Tamagnone, Norberto
Reggiardo, María Virginia
Cheinquer, Hugo
Araujo, Alexandre
Arufe, Diego
Marín, Juan Ignacio
Ratusnu, Natalia
Manero, Estela
Perez, Daniela
Villa, Marina
Orozco, Federico
Murga, Dolores
Marciano, Sebastián
Bessone, Fernando
Silva, Marcelo
Mendizabal, Manuel
author_role author
author2 Anders, Margarita
Bermudez, Carla
Demirdjian, Ezequiel
Varón, Adriana
Palazzo, Ana
Rodriguez, Jorge
Beltrán, Oscar
Gomes da Fonseca, Leonardo
Ridruejo, Ezequiel
Caballini, Pablo
Tamagnone, Norberto
Reggiardo, María Virginia
Cheinquer, Hugo
Araujo, Alexandre
Arufe, Diego
Marín, Juan Ignacio
Ratusnu, Natalia
Manero, Estela
Perez, Daniela
Villa, Marina
Orozco, Federico
Murga, Dolores
Marciano, Sebastián
Bessone, Fernando
Silva, Marcelo
Mendizabal, Manuel
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv LIVER CANCER
OUTCOMES
PROGNOSIS
PROGRESSION
REAL-WORLD
topic LIVER CANCER
OUTCOMES
PROGNOSIS
PROGRESSION
REAL-WORLD
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Introduction and Objectives: With the advent of new therapeutic options for patients with hepatocellular carcinoma (HCC) for intermediate or advanced stages of the Barcelona Clinic Liver Cancer (BCLC), regional real-world data regarding prognostic survival factors are of significant importance. Patients and Methods: A multicenter prospective cohort study was conducted in Latin America including BCLC B or C patients since 15th May 2018. We report here the second interim analysis focusing on prognostic variables and causes of treatment discontinuation. Cox proportional hazard survival analysis was performed, estimating hazard ratios (HR) and 95% confidence intervals (95% CI). Results: Overall, 390 patients were included, 55.1% and 44.9% were BCLC B and C at the time of study enrollment. Cirrhosis was present in 89.5% of the cohort. Among the BCLC-B group, 42.3% were treated with TACE with a median survival since the first session of 41.9 months. Liver decompensation before TACE was independently associated with increased mortality [HR 3.22 (CI 1.64;6.33); P<.001]. Systemic treatment was initiated in 48.2% of the cohort (n=188), with a median survival of 15.7 months. Of these, 48.9% presented first-line treatment discontinuation (44.4% tumor progression, 29.3% liver decompensation, 18.5% symptomatic deterioration, and 7.8% intolerance), and only 28.7% received second-line systemic treatments. Liver decompensation [HR 2.9 (1.64;5.29); P<.0001], and symptomatic progression [HR 3.9 (1.53;9.78); P=0.004] were independently associated with mortality after first-line systemic treatment discontinuation. Conclusions: The complexity of these patients, with one-third presenting liver decompensation after systemic therapies, underlines the need for multidisciplinary team management and the central role of hepatologists.
Fil: Piñero, Federico. Universidad Austral. Hospital Universitario Austral; Argentina
Fil: Anders, Margarita. Hospital Alemán; Argentina
Fil: Bermudez, Carla. Hospital Italiano; Argentina
Fil: Demirdjian, Ezequiel. Instituto Médico Sagrado Corazón; Argentina
Fil: Varón, Adriana. Fundación Cardioinfantil. Instituto de Cardiología; Colombia
Fil: Palazzo, Ana. Gobierno de la Provincia de Tucumán. Hospital Ángel Padilla; Argentina
Fil: Rodriguez, Jorge. Hospital San Juan de Dios;
Fil: Beltrán, Oscar. Fundación Cardioinfantil. Instituto de Cardiología; Colombia
Fil: Gomes da Fonseca, Leonardo. Universidade de Sao Paulo; Brasil
Fil: Ridruejo, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina
Fil: Caballini, Pablo. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina
Fil: Tamagnone, Norberto. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina
Fil: Reggiardo, María Virginia. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina
Fil: Cheinquer, Hugo. Universidade Federal do Rio Grande do Sul; Brasil
Fil: Araujo, Alexandre. Universidade Federal do Rio Grande do Sul; Brasil
Fil: Arufe, Diego. Instituto Médico Sagrado Corazón; Argentina
Fil: Marín, Juan Ignacio. Hospital Pablo Tobon Uribe; Colombia
Fil: Ratusnu, Natalia. Hospital Regional de Ushuaia; Argentina
Fil: Manero, Estela. Hospital Pablo Soria; Argentina
Fil: Perez, Daniela. Gobierno de la Provincia de Tucumán. Hospital Ángel Padilla; Argentina
Fil: Villa, Marina. Hospital Comarcal de Blanes; Argentina
Fil: Orozco, Federico. Hospital Alemán; Argentina
Fil: Murga, Dolores. Gobierno de la Provincia de Tucumán. Hospital Ángel Padilla; Argentina
Fil: Marciano, Sebastián. Hospital Italiano; Argentina
Fil: Bessone, Fernando. Provincia de Santa Fe. Ministerio de Salud y Medio Ambiente - Rosario. Hospital Provincial del Centenario; Argentina
Fil: Silva, Marcelo. Universidad Austral. Hospital Universitario Austral; Argentina
Fil: Mendizabal, Manuel. Universidad Austral. Hospital Universitario Austral; Argentina
description Introduction and Objectives: With the advent of new therapeutic options for patients with hepatocellular carcinoma (HCC) for intermediate or advanced stages of the Barcelona Clinic Liver Cancer (BCLC), regional real-world data regarding prognostic survival factors are of significant importance. Patients and Methods: A multicenter prospective cohort study was conducted in Latin America including BCLC B or C patients since 15th May 2018. We report here the second interim analysis focusing on prognostic variables and causes of treatment discontinuation. Cox proportional hazard survival analysis was performed, estimating hazard ratios (HR) and 95% confidence intervals (95% CI). Results: Overall, 390 patients were included, 55.1% and 44.9% were BCLC B and C at the time of study enrollment. Cirrhosis was present in 89.5% of the cohort. Among the BCLC-B group, 42.3% were treated with TACE with a median survival since the first session of 41.9 months. Liver decompensation before TACE was independently associated with increased mortality [HR 3.22 (CI 1.64;6.33); P<.001]. Systemic treatment was initiated in 48.2% of the cohort (n=188), with a median survival of 15.7 months. Of these, 48.9% presented first-line treatment discontinuation (44.4% tumor progression, 29.3% liver decompensation, 18.5% symptomatic deterioration, and 7.8% intolerance), and only 28.7% received second-line systemic treatments. Liver decompensation [HR 2.9 (1.64;5.29); P<.0001], and symptomatic progression [HR 3.9 (1.53;9.78); P=0.004] were independently associated with mortality after first-line systemic treatment discontinuation. Conclusions: The complexity of these patients, with one-third presenting liver decompensation after systemic therapies, underlines the need for multidisciplinary team management and the central role of hepatologists.
publishDate 2023
dc.date.none.fl_str_mv 2023-07
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/229129
Piñero, Federico; Anders, Margarita; Bermudez, Carla; Demirdjian, Ezequiel; Varón, Adriana; et al.; Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC; Mexican Association of Hepatology; Annals of Hepatology; 28; 4; 7-2023; 1-7
1665-2681
CONICET Digital
CONICET
url http://hdl.handle.net/11336/229129
identifier_str_mv Piñero, Federico; Anders, Margarita; Bermudez, Carla; Demirdjian, Ezequiel; Varón, Adriana; et al.; Liver decompensation is a frequent cause of treatment discontinuation and prognostic factor in intermediate-advanced HCC; Mexican Association of Hepatology; Annals of Hepatology; 28; 4; 7-2023; 1-7
1665-2681
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/doi/10.1016/j.aohep.2023.101110
info:eu-repo/semantics/altIdentifier/url/https://www.sciencedirect.com/science/article/pii/S1665268123002144
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Mexican Association of Hepatology
publisher.none.fl_str_mv Mexican Association of Hepatology
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 13.25334

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