PMC6856073_01
The levels of serum CA19-9 (normal range, 0-22 U/mL) before and after apatinib treatment. CA19-9, cancer antigen 19-9; DDP, cisplatin; GEM, gemcitabine; CAPE, capecitabine; CPT-11, irinotecan; L-OHP, oxaliplatin.
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F1
The preoperative serum CA19-9 was 731.30 U/mL (normal range, 0-22 U/mL) on November 24, 2015 (Figure 1), and then postoperative level decreased to 110.20 U/mL on March 23, 2016.
(A1-A4) A chest CT scan showed multiple metastases of both lungs. Total abdominal CT scan revealed a 7.8 x 6.9 cm mass located in the original gallbladder area, accompanied by abdominal and retroperitoneal lymph node metastasis (September 1, 2018); (B1-B4) A chest CT scan and T2-weighted abdominal MRI on November 16, 2018. The density of pulmonary metastases had considerably decreased with cavity formation compared with that in (A1-A3). Tumor shrinkage was confirmed 2 months after apatinib was orally administered. (C1-C4) A chest CT scan and T2-weighted abdominal MRI on February 20, 2019. The mass located in the original gallbladder area reduced to the point of vanishing completely. (D1-D4) A chest CT scan and T2-weighted abdominal MRI on June 12, 2019. (E1-E4) A chest CT scan and T2-weighted abdominal MRI on September 16, 2019. CT, computed tomography; MRI, magnetic resonance imaging.
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F2
After seven cycles of the last chemotherapy regimen, the enhanced total abdominal CT scan on September 1, 2018, revealed a 7.8 x 6.9 cm mass located in the original gallbladder area (or the anastomotic stoma), accompanied by abdominal and retroperitoneal lymph node metastasis (Figures 2A1-A4). MRI re-examination within 2 months (November 16, 2018), with impressive reductions in both the numbers and size of the abdominal and retroperitoneal lymph node as well as the mass located in the anastomotic stoma, which shrunk to 5.2 x 3.1 cm (Figures 2B1-B4). Meanwhile, the density of the pulmonary metastases had considerably decreased with cavity formation. On February 20, 2019, the mass mentioned had reduced and vanished completely according to the diagnostic MRI (Figures 2C1-C4), and this was coupled with a normal level of serum 19-9. Although the levels of serum CA19-9 were slightly increased, the efficacy of PR was sustained for more than 10 months until the last reexamination (September 19, 2019), and this has since continued (Figures 2D1-D4,E1-E4).