ALINE LOPES CHAGAS

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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/07 - Laboratório de Gastroenterologia Clínica e Experimental, Hospital das Clínicas, Faculdade de Medicina

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  • article 0 Citação(ões) na Scopus
    The leading and key role of hepatologists in the multidisciplinary management of patients with hepatocellular carcinoma
    (2023) MARIN, Juan Ignacio; ANDERS, Margarita; CHAGAS, Aline; MENENDEZ, Josemaria; BELTRAN, Oscar; ESTUPINAN, Enrique Carrera; FERRER, Javier Diaz; MATTOS, Angelo A.; PINERO, Federico
  • article 0 Citação(ões) na Scopus
    Performance of pre-transplant criteria in prediction of hepatocellular carcinoma progression and waitlist dropout
    (2022) PINERO, Federico; THOMPSON, Marcos; BOIN, Ilka; CHAGAS, Aline; QUINONEZ, Emilio; BERMUDEZ, Carla; VILATOBA, Mario; SANTOS, Luisa; ANDERS, Margarita; DUQUE, Sergio Hoyos; LIMA, Agnaldo Soares; MENENDEZ, Josemaria; PADILLA, Martin; PONIACHIK, Jaime; ZAPATA, Rodrigo; MARASCHIO, Martin; MENENDEZ, Ricardo Chong; MUNOZ, Linda; ARUFE, Diego; FIGUEROA, Rodrigo; PERALES, Simone R.; MACCALI, Claudia; SANDOVAL, Rodrigo Vergara; MCCORMACK, Lucas; VARON, Adriana; MARCIANO, Sebastian; MATTERA, Juan; CARRILHO, Flair; SILVA, Marcelo
    Background & aim Liver transplantation (LT) selection models for hepatocellular carcinoma (HCC) have not been proposed to predict waitlist dropout because of tumour progression. The aim of this study was to compare the alpha-foetoprotein (AFP) model and other pre-LT models in their prediction of HCC dropout. Methods A multicentre cohort study was conducted in 20 Latin American transplant centres, including 994 listed patients for LT with HCC from 2012 to 2018. Longitudinal tumour characteristics, and patterns of progression were recorded at time of listing, after treatments and at last follow-up over the waitlist period. Competing risk regression models were performed, and model's discrimination was compared estimating Harrell's adapted c-statistics. Results HCC dropout rate was significantly higher in patients beyond (24% [95% CI 16-28]) compared to those within Milan criteria (8% [95% IC 5%-12%]; p < .0001), with a SHR of 3.01 [95% CI 2.03-4.47]), adjusted for waiting list time and bridging therapies (c-index 0.63 [95% CI 0.57; 0.69). HCC dropout rates were higher in patients with AFP scores >2 (adjusted SHR of 3.17 [CI 2.13-4.71]), c-index of 0.71 (95% CI 0.65-0.77; p = .09 vs Milan). Similar discrimination power for HCC dropout was observed between the AFP score and the Metroticket 2.0 model. In patients within Milan, an AFP score >2 points discriminated two populations with a higher risk of HCC dropout (SHR 1.68 [95% CI 1.08-2.61]). Conclusions Pre-transplant selection models similarly predicted HCC dropout. However, the AFP model can discriminate a higher risk of dropout among patients within Milan criteria.
  • article 3 Citação(ões) na Scopus
    Liver transplantation for hepatocellular carcinoma: impact of expansion criteria in a multicenter cohort study from a high waitlist mortality region
    (2021) PINERO, Federico; ANDERS, Margarita; BOIN, Ilka F.; CHAGAS, Aline; QUINONEZ, Emilio; MARCIANO, Sebastian; VILATOBA, Mario; SANTOS, Luisa; DUQUE, Sergio Hoyos; LIMA, Agnaldo Soares; MENENDEZ, Josemaria; PADILLA, Martin; PONIACHIK, Jaime; ZAPATA, Rodrigo; SOZA, Alejandro; MARASCHIO, Martin; MENENDEZ, Ricardo Chong; MUNOZ, Linda; ARUFE, Diego; FIGUEROA, Rodrigo; ATAIDE, Elaine Cristina de; MACCALI, Claudia; SANDOVAL, Rodrigo Vergara; BERMUDEZ, Carla; PODESTA, Luis G.; MCCORMACK, Lucas; VARON, Adriana; GADANO, Adrian; MATTERA, Juan; VILLAMIL, Federico; RUBINSTEIN, Fernando; CARRILHO, Flair; SILVA, Marcelo
    This study aimed to compare liver transplantation (LT) outcomes and evaluate the potential rise in numbers of LT candidates with hepatocellular carcinoma (HCC) of different allocation policies in a high waitlist mortality region. Three policies were applied in two Latin American cohorts (1085 HCC transplanted patients and 917 listed patients for HCC): (i) Milan criteria with expansion according to UCSF downstaging (UCSF-DS), (ii) the AFP score, and (iii) restrictive policy or Double Eligibility Criteria (DEC; within Milan + AFP score <= 2). Increase in HCC patient numbers was evaluated in an Argentinian prospective validation set (INCUCAI; NCT03775863). Expansion criteria in policy A showed that UCSF-DS [28.4% (CI 12.8-56.2)] or ""all-comers"" [32.9% (CI 11.9-71.3)] had higher 5-year recurrence rates compared to Milan, with 10.9% increase in HCC patients for LT. The policy B showed lower recurrence rates for AFP scores <= 2 points, even expanding beyond Milan criteria, with a 3.3% increase. Patients within DEC had lower 5-year recurrence rates compared with those beyond DEC [13.3% (CI 10.1-17.3) vs 24.2% (CI 17.4-33.1; P = 0.0006], without significant HCC expansion. In conclusion, although the application of a stricter policy may optimize the selection process, this restrictive policy may lead to ethical concerns in organ allocation (NCT03775863).
  • article 1 Citação(ões) na Scopus
  • conferenceObject
    TREATMENT WITH DIRECT-ACTING ANTIVIRALS (DAAS) NEITHER INCREASES THE RISK OF HEPATOCELLULAR CARCINOMA PROGRESSION DURING WAITING LIST NOR RECURRENCE AFTER LIVER TRANSPLANTATION
    (2019) PINERO, Federico; BOIN, Ilka; RUBINSTEIN, Fernando; CHAGAS, Aline; QUINONEZ, Emilio; MARCIANO, Sebastian; VILATOBA, Mario; VARON, Adriana; ANDERS, Margarita; DUQUE, Sergio Hoyos; LIMA, Agnaldo Soares; MENENDEZ, Josemaria; PADILLA, Martin; PONIACHICK, Jaime; ZAPATA, Rodrigo; BARRABINO, Martin; MENENDEZ, Ricardo Chong; MUNOZ, Linda; ARUFE, Diego; FIGUEROA, Rodrigo; MENDIZABAL, Manuel; ZANAGA, Leticia; MACCALI, Claudia; SANDOVAL, Rodrigo Vergara; BARMUDEZ, Carla; BELTRAN, Oscar; AENAS, Isabel; GERONA, Solange; IRACHETA, Alexis; GINESTA, Alexandra; GADANO, Adrian; MATTERA, Juan; STUCCHI, Raquel; CARRILLO, Flair; SILVA, Mauricio
  • article 3 Citação(ões) na Scopus
  • article 10 Citação(ões) na Scopus
    Direct-Acting Antivirals and Hepatocellular Carcinoma: No Evidence of Higher Wait-List Progression or Posttransplant Recurrence
    (2020) PINERO, Federico; BOIN, Ilka; CHAGAS, Aline; QUINONEZ, Emilio; MARCIANO, Sebastian; VILATOBA, Mario; SANTOS, Luisa; ANDERS, Margarita; DUQUE, Sergio Hoyos; LIMA, Agnaldo Soares; MENENDEZ, Josemaria; PADILLA, Martin; PONIACHIK, Jaime; ZAPATA, Rodrigo; MARASCHIO, Martin; MENENDEZ, Ricardo Chong; MUNOZ, Linda; ARUFE, Diego; FIGUEROA, Rodrigo; MENDIZABAL, Manuel; GOMEZ, Sahara Hurtado; STUCCHI, Raquel; MACCALI, Claudia; SANDOVAL, Rodrigo Vergara; BERMUDEZ, Carla; MCCORMACK, Lucas; VARON, Adriana; GADANO, Adrian; MATTERA, Juan; RUBINSTEIN, Fernando; CARRILHO, Flair; SILVA, Marcelo
    The association between direct-acting antivirals (DAAs) and hepatocellular carcinoma (HCC) wait-list progression or its recurrence following liver transplantation (LT) remains uncertain. We evaluated the impact of DAAs on HCC wait-list progression and post-LT recurrence. This Latin American multicenter retrospective cohort study included HCC patients listed for LT between 2012 and 2018. Patients were grouped according to etiology of liver disease: hepatitis C virus (HCV) negative, HCV+ never treated with DAAs, and HCV+ treated with DAAs either before or after transplantation. Multivariate competing risks models were conducted for both HCC wait-list progression adjusted by a propensity score matching (pre-LT DAA effect) and for post-LT HCC recurrence (pre- or post-LT DAA effect). From 994 included patients, 50.6% were HCV-, 32.9% were HCV+ never treated with DAAs, and 16.5% were HCV+ treated with DAAs either before (n = 66) or after LT (n = 98). Patients treated with DAAs before LT presented similar cumulative incidence of wait-list tumor progression when compared with those patients who were HCV+ without DAAs (26.2% versus 26.9%; P = 0.47) and a similar HCC-related dropout rate (12.1% [95% CI, 0.4%-8.1%] versus 12.9% [95% CI, 3.8%-27.2%]), adjusted for baseline tumor burden, alpha-fetoprotein values, HCC diagnosis after listing, bridging therapies, and by the probability of having received or not received DAAs through propensity score matching (subhazard ratio [SHR], 0.9; 95% CI, 0.6-1.6; P = 0.95). A lower incidence of posttransplant HCC recurrence among HCV+ patients who were treated with pre- or post-LT DAAs was observed (SHR, 0.7%; 95% CI, 0.2%-4.0%). However, this effect was confounded by the time to DAA initiation after LT. In conclusion, in this multicenter cohort, HCV treatment with DAAs did not appear to be associated with an increased wait-list tumor progression and HCC recurrence after LT.
  • article 7 Citação(ões) na Scopus
    Recurrence of hepatocellular carcinoma after liver transplantation: Prognostic and predictive factors of survival in a Latin American cohort
    (2021) MACCALI, Claudia; CHAGAS, Aline L.; BOIN, Ilka; QUINONEZ, Emilio; MARCIANO, Sebastian; VILATOBA, Mario; VARON, Adriana; ANDERS, Margarita; DUQUE, Sergio Hoyos; LIMA, Agnaldo S.; MENENDEZ, Josemaria; PADILLA-MACHACA, Martin; PONIACHIK, Jaime; ZAPATA, Rodrigo; MARASCHIO, Martin; MENENDEZ, Ricardo Chong; MUNOZ, Linda; ARUFE, Diego; FIGUEROA, Rodrigo; SOZA, Alejandro; FAUDA, Martin; PERALES, Simone R.; SANDOVAL, Rodrigo Vergara; BERMUDEZ, Carla; BELTRAN, Oscar; HOYOS, Isabel Arenas; MCCORMACK, Lucas; MATTERA, Francisco Juan; GADANO, Adrian; GARCIA, Jose H. Parente; TANI, Claudia Megumi; D'ALBUQUERQUE, Luiz Augusto Carneiro; CARRILHO, Flair J.; SILVA, Marcelo; PINERO, Federico
    Background & Aim Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) has a poor prognosis, and the adjusted effect of different treatments on post-recurrence survival (PRS) has not been well defined. This study aims to evaluate prognostic and predictive variables associated with PRS. Methods This Latin American multicenter retrospective cohort study included HCC patients who underwent LT between the years 2005-2018. We evaluated the effect of baseline characteristics at time of HCC recurrence diagnosis and PRS (Cox regression analysis). Early recurrences were those occurring within 12 months of LT. To evaluate the adjusted treatment effect for HCC recurrence, a propensity score matching analysis was performed to assess the probability of having received any specific treatment for recurrence. Results From a total of 1085 transplanted HCC patients, the cumulative incidence of recurrence was 16.6% (CI 13.5-20.3), with median time to recurrence of 13.0 months (IQR 6.0-26.0). Factors independently associated with PRS were early recurrence (47.6%), treatment with sorafenib and surgery/trans-arterial chemoembolization (TACE). Patients who underwent any treatment presented ""early recurrences"" less frequently, and more extrahepatic metastasis. This unbalanced distribution was included in the propensity score matching, with correct calibration and discrimination (receiving operator curve of 0.81 [CI 0.72;0.88]). After matching, the adjusted effect on PRS for any treatment was HR of 0.2 (0.10;0.33); P < .0001, for sorafenib therapy HR of 0.4 (0.27;0.77); P = .003, and for surgery/TACE HR of 0.4 (0.18;0.78); P = .009. Conclusion Although early recurrence was associated with worse outcome, even in this population, systemic or locoregional treatments were associated with better PRS.
  • article 10 Citação(ões) na Scopus
    International study on the outcome of locoregional therapy for liver transplant in hepatocellular carcinoma beyond Milan criteria
    (2021) DEGROOTE, Helena; PINERO, Federico; COSTENTIN, Charlotte; NOTARPAOLO, Andrea; BOIN, Ilka F.; BOUDJEMA, Karim; BACCARO, Cinzia; CHAGAS, Aline Lopes; BACHELLIER, Philippe; ETTORRE, Giuseppe Maria; PONIACHIK, Jaime; MUSCARI, Fabrice; BENEDETTO, Fabrio Di; DUQUE, Sergio Hoyos; SALAME, Ephrem; CILLO, Umberto; GADANO, Adrian; VANLEMMENS, Claire; FAGIUOLI, Stefano; RUBINSTEIN, Fernando; BURRA, Patrizia; CHERQUI, Daniel; SILVA, Marcelo; VLIERBERGHE, Hans Van; DUVOUX, Christophe
    Background & Aims: Good outcomes after liver transplantation (LT) have been reported after successfully downstaging to Milan criteria in more advanced hepatocellular carcinoma (HCC). We aimed to compare post-LT outcomes in patients receiving locoregional therapies (LRT) before LT according to Milan criteria and University of California San Francisco downstaging (UCSF-DS) protocol and 'all-comers'. Methods: This multicentre cohort study included patients who received any LRT before LT from Europe and Latin America (2000-2018). We excluded patients with alpha-foetoprotein (AFP) above 1,000 ng/ml. Competing risk regression analysis for HCC recurrence was conducted, estimating subdistribution hazard ratios (SHRs) and corresponding 95% CIs. Results: From 2,441 LT patients, 70.1% received LRT before LT (n = 1,711). Of these, 80.6% were within Milan, 12.0% within UCSF-DS, and 7.4% all-comers. Successful downstaging was achieved in 45.2% (CI 34.8-55.8) and 38.2% (CI 25.4-52.3) of the UCSF-DS group and all-comers, respectively. The risk of recurrence was higher for all-comers (SHR 6.01 [p <0.0001]) and not significantly higher for the UCSF-DS group (SHR 1.60 [p = 0.32]), compared with patients remaining within Milan. The allcomers presented more frequent features of aggressive HCC and higher tumour burden at explant. Among the UCSF-DS group, an AFP value of QO ng/ml at listing was associated with lower recurrence (SHR 2.01 [p = 0.006]) and better survival. However, recurrence was still significantly high irrespective of AFP 520 ng/ml in all-comers. Conclusions: Patients within the UCSF-DS protocol at listing have similar post-transplant outcomes compared with those within Milan when successfully downstaged. Meanwhile, all-comers have a higher recurrence and inferior survival irrespective of response to LRT. Additionally, in the UCSF-DS group, an ALP of 520 ng/ml might be a novel tool to optimise selection of candidates for LT. (C) 2021 The Authors.
  • conferenceObject
    LISTING, DROPOUT AND TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA IN LATIN AMERICA: UNEXPECTED AND PREVIOUSLY NOT REPORTED RESULTS
    (2019) PINERO, Federico; BOIN, Ilka; CHAGAS, Aline; QUINONEZ, Emilio; MARCIANO, Sebastian; VILATOBA, Mario; VARON, Adriana; MCCORMACK, Lucas; DUQUE, Sergio; LIMA, Agnaldo Soares; MENENDEZ, Josemaria; PADILLA, Martin; PONIACHIK, Jaime; ZAPATA, Rodrigo; MARASCHIO, Martin; MENENDE, Ricardo Chong; MUNHOZ, Linda; ARUFE, Diego; FIGUEROA, Rodrigo; CAMPANA, Ariel Gonzalez; PERALES, Simone Reges; MACCALI, Claudia; SANDOVAL, Rodrigo Vergara; BERMUDEZ, Carla; SANTOS, Luiza; BALMER, Matias; ARENAS, Isabel; GERONA, Solange; HENRIQUEZ, Victor; GINESTA, Alexandra; BARRABINO, Martin; RAFFA, Pia; GADANO, Adrian; MATTERA, Juan; ATAIDE, Elaine Cristina; CARRILHO, Flair; SILVA, Marcelo