66. 關於中期肝癌 TACE unsuitable 的範圍，2020 APPLE Expert Consensus Statement 與 BCLC 2022 update 比較，其中包括下列何種共同項目？
(1) Up-to-7 out
(2) Infiltrative type
(3) Bilobar extensive HCC
(4) Extranodular growth type HCC
(5) Poorly differentiated HCC
(A) (2)＋(3)
(B) (1)＋(2)＋(3)
(C) (2)＋(3)＋(4)＋(5)
(D) (2)＋(3)＋(5)

(E) (1)＋(2)＋(3)＋(4)＋(5)

62. 五十四歲男性，有 B 型肝炎合併失代償肝硬化病史，一年來反覆發生嚴重腹水以及食道靜脈瘤出血，最近超音波發現肝臟內新長出 2cm 低回音腫瘤，經腹部斷層掃描檢查高度懷疑是肝細胞癌。住院接受肝移植評估。下列有關肝移植的敘述，何者為是？(1) 失代償肝硬化病患，反覆發生嚴重腹水以及食道靜脈瘤出血是接受肝移植的條件之一。(2) 失代償肝硬化病患，發生肝細胞癌是接受肝移植的禁忌症之一。(3) 嚴重心血管疾病以及肝外癌症存在也是肝移植的禁忌症。(4) Model for End-Stage Liver Disease(MELD)可以協助評估肝病嚴重度，常用來決定肝移植的優先順序。(5) 在台灣最常見肝移植的原因是病毒性肝炎導致失代償肝硬化。(A) (1)＋(2)＋(3)＋(4)＋(5)(B) (1)＋(2)＋(3)＋(5)(C) (1)＋(3)＋(4)＋(5)(D) (1)＋(3)＋(5)(E) (1)＋(5)

63. 六十歲男性，有 B 型肝炎合併肝硬化病史，一星期前門診定期追蹤抽血檢驗腎功能 creatinine 0.7 mg/dL。主訴最近這星期尿量減少來急診求診，抽血檢驗腎功能creatinine 為 1.5 mg/dL，臨床診斷為 hepatorenal syndrome(HRS)。下列有關HRS 的敘述，何者為是？(1) 屬於功能性急性腎衰竭，腎臟外表沒有明顯病變，沒有顯著蛋白尿(2) 病理生理學可以觀察到腎動脈收縮(3) Type II HRS 的特色是腎功能快速惡化，兩星期內血清 creatinine 值顯著爬升(4) 治療方面須給予 albumin volume replacement 合併高劑量利尿劑增加小便量(5) 肝移植是最佳治療策略(A) (2)＋(3)＋(4)＋(5)(B) (1)＋(2)＋(3)＋(5)(C) (1)＋(2)＋(4)＋(5)(D) (1)＋(3)＋(4)＋(5)(E) (1)＋(2)＋(5)

64. 二十五歲男性，過去身體沒有任何疾病，因進公司上班前接受健檢，腹部超音波在肝右葉意外發現 3cm 低回音病灶。試問下列敘述，何者為非？(1) 年輕男性沒有任何病史，不可能是惡性腫瘤(2) 應直接進行腫瘤切片檢查確認腫瘤本質(3) 腹部超音波在鑑別診斷上沒有任何幫忙(4) 癌症指標對鑑別診斷上有很高的價值(5) 定期影像追蹤也是判斷良惡性腫瘤的策略之一(A) (1)＋(2)＋(3)＋(4)＋(5)(B) (1)＋(2)＋(3)＋(4)(C) (1)＋(2)＋(4)＋(5)(D) (1)＋(2)＋(3)＋(5)(E) (1)＋(4)＋(5)

65. 下列關於核(苷)酸類似物(nucleoside or nucleotide analogs)在慢性 B 型肝炎之治療，何者描述正確？(1) 針對 HBeAg 陽性患者須長期使用，直到 e 抗原血清陰轉，再施予鞏固療法一年，可以降低停藥後復發(relapse)的機率。(2) 針對 HBeAg 陰性患者須終身使用口服藥，因為停藥後病毒學復發與臨床復發的機率非常高。(3) 針對肝硬化患者須避免終身使用口服藥，因為會降低功能性痊癒的機會。(4) 準備停藥當下可以檢測血清 HBsAg 濃度，一般而言 HBsAg 濃度越低(例如小於 100 ng/mL)停藥後復發機率愈低。(5) 停藥後一旦發生病毒學復發，應馬上給予抗病毒藥物治療避免肝失代償風險。(A) (1)＋(2)＋(3)＋(4)＋(5)(B) (1)＋(2)＋(3)＋(4)(C) (1)＋(3)＋(4)(D) (1)＋(4)＋(5)(E) (1)＋(4)

67. 依據 2018 AASLD Guidelines for the Treatment of Hepatocellular Carcinoma，下列何者敘述正確？(1) The AASLD suggests that patients beyond the Milan criteria (T3) should beconsidered for liver trans-plantation after successful downstaging into the Milan criteria.(2) The AASLD recommends LRT over no treatment in adults with cirrhosis andHCC (T2 or T3, no vascular involvement) who are not candidates for resection or transplantation.(3) The AASLD suggests routine use of adjuvant therapy for patients with HCC following successful resection or ablation.(4) The AASLD suggests not performing surveillance of patients with Child-Pugh class C cirrhosis unless they are on the transplant waiting list.(A) (3)＋(4)(B) (1)＋(2)(C) (3)(D) (1)＋(2)＋(4)(E) (1)＋(2)＋(3)＋(4)

68. 關於 Liver Imaging Reporting and Data System (LI-RADS) system，下列敘述何者錯誤？(1) LI-RADS 1 and LI-RADS2 indicate definitely and probably benign.(2) LI-RADS 5 indicates definite HCC.(3) “a small nodular area of CT/MR arterial phase hyperenhancement, which isnot present on other phases” is classified as LI-RADS 2.(4) “a ≥2-cm encapsulated lesion with CT/MR arterial phasehyperenhancement, but without “washout” is classified as LI-RADS 4.(5) “a ≥2-cm lesion that enhances to the same degree as liver in the CT/MRarterial phase, but enhances less (i.e., is hypoenhanced) in the postarterial phases” is classified as LI-RADS 4.(A) (1)＋(4)(B) (2)＋(3)(C) (3)(D) (2)＋(3)＋(5)(E) (3)＋(5)

69. 關於 Liver Imaging Reporting and Data System (LI-RADS) system，下列敘述何者錯誤？(1) A LI-RADS 2 lesion has an average probability of HCC of 33%.(2) A LI-RADS 4 lesion has an average probability of HCC of 80%.(3) For LI-RADS M lesions, 42% had HCC and 57% had another tumor besides HCC.(4) 6%-15% of LI-RADS 3 lesions followed prospectively were diagnosed as HCC or other malignancy by 24 months.(5) Threshold growth (= size increase of a mass by ≥ 50% in ≤ 6 months) is a criterion for LI-RADS 4.(A) (1)＋(5)(B) (1)(C) (1)＋(4)(D) (1)＋(3)＋(5)(E) (1)＋(3)

70. 依據 2018 AASLD practice guidance，關於 HCC 診斷，下列敘述何者正確？(1) Diagnosis of HCC can be made by imaging in patients without cirrhosis, ifenhancement and washout are present.(2) Histological markers GPC3, HSP70, and GS can be assessed to distinguishhigh-grade dysplasia from HCC on histology if HCC cannot be diagnosed based on routine histology.(3) A lesion of ＞1 cm on ultrasound (US) should trigger recall procedures for the diagnosis of HCC.(4) If using AFP with US, then an AFP ＞20 ng/mL should trigger recall procedures for diagnosis of HCC.(A) (1)(B) (2)＋(3)(C) (1)＋(4)(D) (2)＋(3)＋(4)(E) (1)＋(2)＋(3)＋(4)

71. GALAD model 可以運用在 HCC 診斷，下列何者不屬於 GALAD model 的組成項目？(A) Gender(B) AFP and AFP-L3%(C) DCP (protein induced by vitamin K absence/antagonist-II)(D) Age(E) Alcohol

72. 依據 BCLC 2022 update，下列何者錯誤？(1) For solitary HCC, the presence of CSPH (defined by a hepatic venous pressure gradient [HVPG] ＞10 mmHg) is the key consideration to decide treatment option.(2) For BCLC A, multifocal disease still within the Milan criteria is better served by liver transplantation (LT).(3) For BCLC 0, LT is not considered.(4) BCLC A is defined as solitary HCC irrespective of size or as a multifocal HCC up to 3 nodules (none of them ＞3 cm), without macrovascular invasion, extrahepatic spread or cancer-related symptoms.(A) (3)(B) (2)(C) (2)＋(3)(D) (3)＋(4)(E) (2)＋(5)