Objective To construct a new staging scheme for patients with hepatocellular carcinoma(HCC).Methods A retrospective analysis of HCC cases from 1999 to 2003 was performed.The Cox model was used for multivariate analyses.The final model was derived from 10 randomly-chosen training samples and the prognostic validity of the new staging score was assessed on the corresponding testing samples.Results A simple scoring system was produced,assigning linear scores(0/1/2) to the covariates (TNM,?-fetoprotein,and Child-Pugh).Compared with Okuda stage and CLIP score,the new staging system,structured as a five-category tool,had a greater discriminant ability.Conclusion The new staging system,accounting for both liver function and tumor characteristics,can accurately identify patients with different prognoses,particularly in the advanced phases of HCC,thus representing a useful tool in the treatment of the disease.

Tumor related-inflammation is important component of tumor microenvironment. The inflammation status in tumor microenvironment may demolish immunosystem, influence signaling transduction and change the homing of normal stem cell in tumor microenvironment, which probably promote tumor development. The better understanding of molecular pathway of tumor related inflammation would be helpful for identification of novel molecular targets.

High-altitude hypoxia is closely associated with cancer initiation and progression.Hypoxia promotes tumor development through multiple mechanisms including modifying acidic microenvironment,triggering tumor angiogenesis,influencing vasculogenic mimicry,inducing epithelial-mesenchymal transition,remodeling of extracellular matrix,promoting immune escape and adaptive landscapes,maintaining cancer stem cells and inhibiting senescence.Targeting hypoxia may become a novel efficient strategy for cancer therapy.

Maintenance therapy is an important strategy for cancer treatment,which mainly include continuation maintenance therapy and switch maintenance therapy,with a classical model of metronomic chemo-therapy.Maintenance therapy can be an effective treatment option for patients with non-small cell lung cancer, breast cancer,colorectal cancer and ovarian cancer.

The conventional treatment options for advanced gastric carcinoma patients remain unsatisfactory in terms of response rate and overall survival benefit. Targeted therapy plus systemic chemotherapy now becomes a new promising therapeutic option. In this review we profiled important trials of international multicenter phase Ⅲ clinical studies in patients with advanced gastric carcinoma, including ToCA trial, EXPAND trial, LOGIC trial, AVAGAST trial, REAL3 trial, and granite-1 trial. These trials warrant the role of molecular targeted therapy in patients with advanced gastric carcinoma.

In patients with initially diagnosed unresectable cancers,resection of cancer sometimes becomes possible by systemic chemotherapy,and this model of chemotherapy is defined as conversion chemo-therapy. Conversion chemotherapy can improve objective response rate and resection rate,and it has shown an important value in metastatic colorectal cancer,advanced gastric cancer and unresectable hepatocellular carci-noma.

Breast cancer is a group of heterogeneous diseases.Molecular portraits provide a new insight for personalized cancer management in breast cancer.According to the molecular pathology,molecular biology and system biology,breast cancer goes through different typing methods,including four subclasses,geneexpression signature and integrated genomic classification.These major subtypes of breast cancer may provide guidance for precise therapeutics.

As semi-autonomous organelles,mitochondria are easily damaged by various factors.Mitochondrial dysfunction such as abnormal oxidative phosphorylation,metabolism alterations,apoptosis prevention,damaged mitophagy,immune escape and deregulated signaling pathway have been hypothesized to be involved in tumorigenesis.Modulated mitochondria may prevent the occurrence of tumors.

Precision chemotherapy is the prospective direction of cancer chemotherapy,which involves the selection of the effective chemotherapy regimens based on the chemotherapy-related genes.Chemotherapyrelated genes include DNA repair genes,drug metabolism enzymes,drug transporters,apoptosis-related genes and cancer-related genes.These genes can predict the response and toxicity of chemotherapy,and determine the clinical outcome.

Metronomic chemotherapy involves antiangiogenic processes that help host to fight against cancer by using continuous low dose drugs.Metronomic chemotherapy can be an effective treatment option for patients with head and neck carcinoma,breast cancer,gastrointestinal cancer,ovarian and prostate cancer. Metronomic chemotherapy also involves multiple mechanisms that include antiangiogenesis,immune stimulation and direct tumor cell targeting effects.We need to carefully evaluate the clinical effects of combination chemo-therapies that incorporate the other treatment schedules.