76. 關於 HCC systemic therapy 的敘述下列何者正確？
(1) Systemic chemotherapy with doxorubicin or FOLFOX did not demonstrate
survival benefits
(2) Lenvatinib targets VEGFR1-3; fibroblast growth factor receptor (FGFR1-4);
platelet-derived growth factor receptor α, RET, and KIT
(3) Cabozantinib is a MET, VEGFR2 and RET inhibitor approved for thyroid,
renal cancer and HCC
(4) Ramucirumab is a monoclonal antibody targeting VEGFR 2
(5) Atezolizumab plus cabozantinib showed a superiority to sorafenib in median progression-free survival (PFS)
(A) (1)＋(2)
(B) (1)＋(2)＋(3)
(C) (2)＋(3)＋(4)
(D) (1)＋(2)＋(3)＋(5)

(E) (1)＋(2)＋(3)＋(4)＋(5)

72. 關於 HCC systemic therapy，依據 phase 3 clinical trials 的結果，下列敘述何者正確？(1) Atezolizumab + Bevacizumab 在一線 systemic therapy，objective responserate (ORR) ＞30%(2) Himalaya trial 受試者，viral HCC 比例＞70%(3) Tremelimumab (300 mg, one dose) plus durvalumab (1500 mg every 4weeks; STRIDE)的 ORR 為 25%(4) Median progression-free survival (PFS)，lenvatinib 不亞於 Atezolizumab +Bevacizumab(A) (1)(B) (1)＋(2)＋(4)(C) (1)＋(3)＋(4)(D) (1)＋(2)＋(3)＋(4)(E) (1)＋(4)

73. 依據 2023 AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma，下列何者敘述正確？(1) Patients with advanced HCC who have Child-Turcotte-Pugh A cirrhosisshould be offered atezolizumab plus bevacizumab or durvalumab plustremelimumab as preferred first-line therapy options(2) Patients with recent GI bleeding within 6 months and those with high-riskstigmata for bleeding on EGD should have varices adequately treated priorto atezolizumab plus bevacizumab initiation, or these patients may beconsidered for durvalumab plus tremelimumab(3) AASLD advises sorafenib or lenvatinib as preferred agents after first-linedurvalumab plus tremelimumab if patients are not eligible for clinical trials(4) Well-selected patients with Child-Turcotte-Pugh B cirrhosis may be offeredsorafenib, lenvatinib, or single-agent anti-PD1 or anti-PDL1 ICI therapy(A) (3)＋(4)(B) (1)＋(2)＋(4)(C) (3)(D) (1)＋(2)＋(3)(E) (1)＋(2)＋(3)＋(4)

74. 關於 Liver Imaging Reporting and Data System (LI-RADS) system，下列敘述何者錯誤？(1) AASLD advises multidisciplinary discussion to determine optimal follow-upfor patients with LI-RADS -3 observations(2) Biopsy should be performed for patients with LR-M observations(3) LI-RADS -5 lesions have a 95%–99% probability of being HCC(4) LI-RADS -3 observations have a ∼30% probability of HCC(5) AASLD advises continued surveillance with repeat CT or MRI in 3–6 monthsfor LI-RAD-2 lesions(A) (1)(B) (2)(C) (1)＋(2)(D) (1)＋(4)＋(5)(E) (1)＋(5)

75. 關於 HCC surveillance test 用於 early HCC detection，下列何者正確？(1) Ultrasound + AFP: sensitivity 約 61%，specificity 約 92%(2) AASLD recommends HCC surveillance using a combination of liverultrasound and AFP(3) GALAD: sensitivity 約 54-72%，specificity 約 90%(4) AFP-L3%: sensitivity 約 50%，specificity 約 80%(5) PIKVA-II: sensitivity 約 40%，specificity 約 81%(A) (1)＋(2)＋(3)(B) (1)＋(2)＋(3)＋(5)(C) (1)＋(2)＋(3)＋(4)(D) (1)＋(2)(E) (1)＋(2)＋(3)＋(4)＋(5)

77. 依據 BCLC 2022 update，下列何者正確？(1) For solitary HCC, the presence of CSPH (defined by a hepatic venouspressure gradient [HVPG] ＞ 10 mmHg) is the key consideration to decidetreatment option(2) BCLC A is defined as solitary HCC irrespective of size or as a multifocalHCC up to 3 nodules (none of them ＞ 3 cm), without macrovascular invasion, extrahepatic spread or cancer-related symptoms(3) The 2022 version of the BCLC staging system does not recommendresection for multinodular HCC within Milan criteria(4) MW (microwave) achieves more extensive tumour necrosis than RF(radiofrequency) and is potentially the best option for those patients withHCC ＞ 4 cm(A) (1)(B) (1)＋(2)(C) (2)＋(3)(D) (1)＋(2)＋(3)(E) (1)＋(2)＋(3)＋(4)

78. 依據 BCLC 2022 update，BCLC B 下列何者錯誤？(1) The treatment options include LT, TACE and systemic therapy(2) Compared to conventional TACE, DEB-TACE has higher tumor responserates and survival(3) AFP higher than 1,000 ng/dl is currently applied as an exclusion criterion ofLT in BCLC B HCC(4) "BCLC upon progression"(BCLCp) classifies as BCLCp-B those patientswho present radiological progression due to growth of existing nodules(≥20%) or new intrahepatic sites but are still within BCLC-B(A) (3)(B) (2)(C) (2)＋(3)(D) (3)＋(4)(E) (1)＋(3)

79. 關於 HCC 免疫治療相關生物標記敘述，下列何者錯誤？(1) CRP 及 AFP 組成的 CRAFITY score 是預測 tumor response 的指標(2) ABRS (atezolizumab-bevacizumab response signature)由 10 個 gene 組成，包括 CD274(3) Gut microbiota 中 Lachnoclostridium 可能與 PFS 及 OS 相關(4) NASH may limit antitumor surveillance in HCC immunotherapy(A) (1)(B) (1)＋(2)＋(3)(C) (1)＋(2)(D) (2)＋(3)＋(4)(E) (1)＋(2)＋(3)＋(4)

80. 關於 Cholangiocarconoma (CCA)的敘述，下列何者正確？(1) Adjuvant chemotherapy with capecitabine for 6 months after surgical resection with curative intent is recommended for intrahepatic CCA, S-1 isan alternative option(2) Liver transplantation is a potentially curative option for intrahepatic andperihilar CCA(3) Entrectinib can be recommended as second- line treatment for NTRK genefusion-positive tumors(4) Durvalumab plus Gemcitabine and Cisplatin significantly improved overallsurvival (OS) versus Gemcitabine plus Cisplatin for advanced biliary tract cancer(5) Cirrhosis is one of the risk factors of intrahepatic CCA(A) (2)＋(4)(B) (1)＋(2)＋(3)＋(4)(C) (2)＋(3)＋(4)(D) (1)＋(2)＋(3)＋(4)＋(5)(E) (1)＋(2)＋(4)

81. 關於膽管癌治療敘述，下列何者為真？(1) 目前取得健保之 FGFR inhibitors 的 pemigatinib 是 pan-FGFR inhibitors(2) 免疫節點抑制劑(immune check point inhibitor)合併化學治療 gemcitabineplus cisplatin，已取得膽管癌第一線治療的適應症(3) 肝內膽管癌的發生率為所有膽道腫瘤中最高(4) isocitrate dehydrogenase(IDH 1/2 mutations)驅動因子突變(driver mutation)，目前已經標靶藥物的臨床試驗成功(A) (1)＋(2)(B) (1)＋(2)＋(3)(C) (1)＋(3)＋(4)(D) (2)＋(4)(E) (1)＋(2)＋(4)

82. 30 歲女性病患，懷孕 34 週發生急性上腹痛，體溫 38˚C，心跳 120/分，血壓85/60mmHg，腹部超音波檢查發現肝內膽管與總膽管擴張，但無明顯結石，膽囊壁正常但有數顆小膽結石，血紅素 13gm/dL，白血球 12,000/uL，血小板170,000/uL，凝血酶元時間(prothrombin time)INR 1.1，麩胺酸丙酮酸轉胺基酶(ALT)360U/L，鹼性磷酸酶(ALP)556U/L，總膽紅素(T-Bil)3.6mg/dL，C-反應蛋白(CRP)180mg/L，下列何者為適當的進一步處理：(A) 腹部電腦斷層(CT)(B) 核磁共振膽胰管攝影(MRCP)(C) 經內視鏡逆行性膽胰管攝影(ERCP)相關治療(D) 引產(E) 期待性治療(expectant management)