79. 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 is an alternative option.
(2) Liver transplantation is a potentially curative option for intrahepatic and perihilar CCA.
(3) FOLFOX (folinic acid, fluorouracil and oxaliplatin) can be recommended as second- line standard of care chemotherapy.
(4) Durvalumab plus Gemcitabine and Cisplatin significantly improved overall survival (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)

75. 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 1-3.(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)

76. 依據 2018 AASLD Guidelines for the Treatment of Hepatocellular Carcinoma，下列何者敘述正確？(1) The AASLD suggests surveillance using ultrasound (US) with or withoutalpha-fetoprotein (AFP) every 6 months.(2) The AASLD suggests observation with follow-up imaging over treatment for patients with cirrhosis awaiting liver transplantation who develop T1 HCC.(3) The AASLD suggests that adults with Child-Pugh class A cirrhosis and resectable T1 or T2 HCC undergo resection over radiofrequency ablation.(4) The AASLD suggests bridging to transplant in patients listed for liver transplantation within OPTN T2 (Milan) criteria to decrease progression of disease and subsequent dropout from the waiting list.(A) (2)＋(3)＋(4)(B) (3)＋(4)(C) (3)(D) (1)＋(2)(E) (1)＋(2)＋(3)＋(4)

77. 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 response rate (ORR) ＞30%。(2) Himalaya trial 受試者，non-viral HCC 比例＞40%。(3) Tremelimumab (300 mg, one dose) plus durvalumab (1500 mg every 4 weeks; STRIDE)的 median progression-free survival (PFS)超越 sorafenib。(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)

78. 關於 HCC radioembolization (TARE) or Selective internal radiation therapy(SIRT)的敘述，下列何者正確？(1) “BCLC 2022 update” suggests that radioembolization is only for single lesion ≤8 cm.(2) Current data demonstrate benefit of TARE compared to sorafenib in patients with advanced HCC.(3) Compared to TACE, SIRT provides significantly longer time to progression and better tumor control, but it does not provide longer survival.(4) SIRT might prepare or select patients for surgery as it induces substantial hypertrophy in the liver lobe contralateral to the target.(A) (3)＋(4)(B) (1)＋(2)＋(3)(C) (2)＋(3)＋(4)(D) (1)＋(2)＋(3)＋(4)(E) (1)＋(3)＋(4)

80. 關於 HCC image diagnostic performance 的敘述，下列何者正確？(1) Dynamic plus hepatobiliary phase MRI had a higher sensitivity and negative predictive value than multiphasic CT and dynamic phase MRI alone.(2) Gadoxetic acid is unique in that approximately 50% of the administrated dose is taken up by the hepatocytes and excreted into the bile ducts.(3) On gadoxetic acid enhanced MRI, hypo-intensity on hepatobiliary phase is regarded as an ancillary finding favoring malignancy.(4) Gadoxetic acid-enhanced MRI has a higher sensitivity for detecting nodules that are either HCC not displaying the typical features of imaging hallmarks or high-grade dysplastic nodules.(A) (2)(B) (1)＋(2)＋(4)(C) (1)＋(2)(D) (1)＋(2)＋(3)＋(4)(E) (2)＋(4)

81. 一位 80 歲失智女性病患，因急性上腹痛至急診住院。理學檢查，病患並無發燒或黃膽，上腹壓痛明顯，但無明顯腹膜症候(peritoneal sign)。生化檢查：ALT:680，AST:580，ALP:120，r-GT:70，amylase:2800，lipase:3200。腹部超音波與電腦斷層顯示輕度脂肪肝，膽囊壁稍微增厚與數顆大於 1 公分的膽結石，膽管未見擴張，胰臟稍腫但無週邊積水。兩天後病患症狀迅速改善，追蹤生化檢查顯示：ALT:270，AST:72，ALP:100，rGT:60，Amylase:85，Lipase:200。病患並無合併其他明顯心血管疾病，但因失智無法配合內視鏡檢查，ERCP 需深度鎮靜施行。下列何者為較適當的後續處理：(1) 照會外科行腹腔鏡膽囊切除術。(2) 照會外科行膽囊切除術與總膽管取石。(3) 偕同麻醉科施行 ERCP，如有結石再施行 EST 取石。(4) 偕同麻醉科不論總膽管是否有結石，直接施行 ERCP/EST/膽管結石清除。(5) 症狀改善不需後續治療。正常值(單位：IU/L)：ALT:7-56，AST:5-35，ALP:38-126，r-GT:8-78，Amylase:30-110，Lipase:7-60。(A) (2)或(4)(B) (1)或(4)(C) (3)或(5)(D) (1)或(5)(E) (1)或(3)

82. 關於膽管癌目前的治療，下列何者為真：(1) 在亞洲肝外膽管癌盛行率較肝內膽管癌高。(2) 晚期癌症目前以 gemcitabine and cisplatin 化療為有效的第一線的治療。(3) 肝內膽管癌中 fibroblast growth factor receptor 2 (FGFR2) fusion 和 isocitrate dehydrogenase (IDH)1/2 mutations 驅動因子突變(driver mutation)，目前有標靶藥物抑制。(4) 免疫檢查點抑制劑(immune check point inhibitor)在 Programmed death ligand 1 (PD-L1) protein expression, mismatch repair deficiency (dMMR)/microsatellite instability high (MSI-H), high tumor mutational burden (TMB)，預期有較佳療效。(A) (2)＋(4)(B) (2)＋(3)＋(4)(C) (1)＋(2)＋(3)(D) (1)＋(3)＋(4)(E) (1)＋(2)＋(3)＋(4)

83. 關於原發性硬化膽管炎(primary sclerosing cholangitis)的描述，下列何者為真：(1) 好發於年輕男性。(2) 高達 50-75%合併有潰瘍性大腸炎(ulcerative colitis)。(3) 以肝臟切片後確診後開始治療。(4) 在病患開始有食道靜脈瘤出血，膽紅素 4 倍上升，腹水或腹膜炎，反覆膽管炎，就應該轉介病患接受肝臟移植。(A) (1)＋(2)＋(3)(B) (2)＋(3)＋(4)(C) (1)＋(3)＋(4)(D) (1)＋(2)＋(4)(E) (1)＋(2)＋(3)＋(4)

84. 膽道結石常繼發於膽囊結石掉落膽管(secondary bile duct stones)。以下有關原發膽管結石(primary bile duct stones)的描述何者為真：(1) 主要成分為 calcium bilirubinate。(2) 外觀為黃色較軟結石(muddy stones)。(3) 結石的形成和膽汁滯留與細菌分解膽只有關。(4) 十二指腸乳突旁憩室也因為容易發生細菌增生而發生膽管結石。(A) (1)＋(2)＋(3)(B) (2)＋(3)＋(4)(C) (1)＋(3)＋(4)(D) (1)＋(2)＋(4)(E) (1)＋(2)＋(3)＋(4)

85. 下列有關懷孕婦女膽結石的描述何者為真：(1) 懷孕時膽囊排空受到影響，容易形成結石。(2) 因膽結石發生疼痛病患，建議懷孕前將膽囊切除。(3) ERCP 相關治療還是可以在中期妊娠(second trimester)減少輻射傷害下執行。(4) 急性膽囊炎在懷孕初期(first trimester)，還是可以安全的施行膽囊切除。(A) (1)＋(2)＋(3)(B) (2)＋(3)＋(4)(C) (1)＋(3)＋(4)(D) (1)＋(2)＋(4)(E) (1)＋(2)＋(3)＋(4)