Cancer stem cells are a kind of cancer cell group with the ability of self-renewal and various diferentiation potentials.Recent studies have implicated that they play a significant role in tumor formation,metastasis,resistance to anticancer therapies and cancer recurrenee.Many studies show that microRNAs are involved in the maintenance,growth and behavior of breast cancer stem cells (BCSCs),paving a new way for diagnosis,prognosis and therapy of breast cancer.

The overexpression of P-glycoprotein(P-gp)and its coding gene mdrl is regarded as the classic mechanism of muhidrug resistance(MDR).Recent studies find that pregnane X receptor(PXR)can mediate the expression of P-gp.It is confirmed that PXR can also inhibit apoptosis of tumor cells.Therefore,preventing the activation of PXR specifically may be a new method to prevent MDR.

A new target in cancer treatment involves tumor-associated macrophages (TAMs) which are infiltrated in microenvi-ronment. By secreting a wide range of cancer-promoting cytokines, such as vascular endothelial growth factor, interleukins, and matrix metalloproteinase, TAMs can promote the proliferation, invasion, and metastasis of cancer cells. Cyclooxygenase-2 (COX-2), an inflam-matory factor that is significant for angiogenesis and immunoregulation within the local microenvironment, may also contribute to can-cer progression and act as a novel target for breast cancer therapy. Several COX-2 inhibitors, such as celecoxib, have shown potential as suppressors of TAMs and the microenvironment. Hence, the current study discusses the crosstalk between TAMs-delivered important cytokines and COX-2 in the breast cancer microenvironment, and then analyzes the value of homologous antagonists alone or in combi-nation with COX-2 inhibitors. This paper aims to provide the theoretical principle of multi-target selection in TAMs blockage, and offer a new direction for biological targeted therapy in breast cancer treatment.

Tumor markers can reflect tumor existence,and open an entrance to diagnose tumor at early stage.Recent researches reveal that gastric cancer related tumor markers such as microRNAs,enzymes,cytokines and antibodies-antigens are significant for the diagnosis,treatment,relapse surveillance,prognosis evaluation of gastric cancer.

Objective To establish docetaxel (Doc) resistant MDA‐MB‐231/Doc model and epirubicin (Epi) resistant MDA‐MB‐231/Epi mode from triple negative breast cancer cell line MDA‐MB‐231 and to explore their biological characteristics .Methods The MDA‐MB‐231/Doc and MDA‐MB‐231/Epi drug‐resistant cell lines were respectively established by gradually increasing Doc or Epi concentrations induction method in 12 months .The biological characteristics of the cell lines were compared by the cell mor‐phological observation ,MTT and flow cytometry ;the real‐time fluorescent quantitative PCR was used to detect multi‐drug resist‐ance gene (MDR1) mRNA expression;the expression of P glycoprotein(P‐gp) ,estrogen receptor (ER) ,progesterone receptor (PR) and human epidermal growth factor receptor 2 (Her‐2) was detected by Western Blot .Results After the 12‐month induction ,the established MDA‐MB‐231/Doc could grow stably in the medium containing 12 nmol/L Doc ,and MDA‐MB‐231/Epi could grow stably in the medium containing 800 nmol/L Epi;in the same drug concentration ,the growth proliferation rate of the drug resistant cell line was significantly higher than that of the parental generation cells ,their drug resistance indexes were 8 .32 times and 64 .93 rimes of parental generation sensitive cells ,moreover which showed the mutual cross drug resistant status .Compared to the parental generation cells ,the cells of stage G1 and G2 in two cell lines were increased and the cells of stage S were decreased ,with the prolon‐gation of drug withdrawal time ,the cell proliferation speed was accelerated .The expression level of MDR1 gene was increased in the two drug‐resistant cell lines ,which were 4 .05 times and 5 .96 times of parental generation cells respectively ,P‐gp protein expression was positive .Compared with the MCF‐7 cell line ,ER ,PR and Her2 expression in the MDA‐MB‐231 cell line was negative and typi‐cal triple negative breast cancer cell line .Conclusion The drug resistance cell lines of MDA‐MB‐231/Doc and MDA‐MB‐231/Epi are successfully established with stable growth and drug resistance .

Objective To explore the change of serum HER2/neu concentration during neoadjuvant chemotherapy for HER2-overexpressed breast cancer and its correlation with the response to the neoadjuvant chemotherapy.Methods The concentration of the serum HER2/neu in 78 cases of HER2-overexpressed advanced breast cancer treated with neoadjuvant chemotherapy were detected with enzyme-linked immunosordent assay(ELISA).The relationship between the serum HER2/neu concentration and the response of neoadjuvant chemotherapy was analyzed.Results The serum HER2/neu concentration of befor and after neoadjuvant chemotherapy was 18.6 ± 10.0ng/ml,11.6 ± 6.lng/ml respectively.The serum HER2/neu concentration decreased significantly(P ＜ 0.001).The response of neoadjuvant chemotherapy was correlated with the change of the serum HER2/neu concentration.The pathologic complete response was correlated with the serum HER2/neu concentration of prechemotherapy and the change of the serum HER2/neu concentration.Conclusion The change of serum HER2/neu concentration may serve as a marker predicting the response of neoadjuvant chemotherapy in HER2-overexpressed breast cancer.

Objective To investigate the compliance with endocrine therapy(ET) and assess the factors associated with treatment accuracy for breast cancer.Methods 379 patients with hormone receptor-positive breast cancer undergoing complete treatment from Jun.2006 to Jun.2008 in Jiangsu Cancer Hospital were followed up.Factors related to compliance were analyzed.Results Among the 322 (85.0％) patients successfully interviewed,15 (4.7％) patients did not receive ET,43 (13.4％) patients stopped taking drugs after discharge,14 (4.3％)patients had intermittent ET,and the rest 250 patients obeyed 5-year oral ET regularly.The treatment accuracy was 77.6％ (250/332).We found that majority of withdraw occurred within 2 months and within 2 years,accounting for 39.5％ and 48.8％,respectively.Job and education status were relevant to these patients.Moreover,too much concern of adverse drug effects and difficulty of long-term medication were the main reasons to noncompliance.Conclusions ET is effective in hormone receptor-positive breast cancer patients and has been used as a conventional therapy.However,due to the long therapeutic period and lack of medical supervision after discharge,its treatment accuracy and compliances are becoming low,resulting in decreased efficiency.It is therefore necessary to investigate such patients' management to improve the compliance and treatment accuracy of ET.

Objective To summarize our experience on diagnosis and treatment of bilateral primary breast cancer (BPBC). Methods Clinicopathologic records, including clinical manifestations, diagnosis and immunohistochemical expressions of 16 patients with BPBC, treated from 2001 to 2009 in Jiangsu Provincial Cancer Hospital, were analyzed retrospectively. Results The 16 patients with BPBC accounted for 0.47% of all patients diagnosed as malignant tumors of breast during the same period in our hospital. All of the 16 patients were women, with the median age of 53 years (ranged 41-69 years). 7 patients were in bilateral synchronous breast cancer (BSBC), with the median age 47 years (ranged 41-54 years), among whom 5 patients got BSBC just before menopause. 9 patients were in bilateral asynchronous breast cancer (BABC), with the median age 58 years (ranged 43-69 years), among whom 1 patient got BABC before menopause. The median interval between the first and second breast carcinoma of BABC was 52 months (ranged 14-196 months). Conclusions Compared with BABC, the occurrence age of the patients with BSBC was smaller. BABC was more common in premenopausal women. The interval time of BABC was irregular. The active follow-up after the occurrence of contralateral breast cancer and endocrine therapy for estrogen receptor-positive patients were recommended.

Objective To explore the expression of human epidermal growth factor receptor -3( HER3) in human epidermal growth factor receptor-2(HER2)-positive breast cancer and its relationship with the therapeutic effect of trastuzumab and clinical prognosis .Methods Clinicopathological characteristics of 235 HER2-positive breast cancer patients undergoing surgery in Jiangsu Cancer Hospital from Jan .2007 to Jun.2012 were analyzed retrospectively.The expression of HER3 was detected using immunohistochemisty staining .The expression of HER3 and its correlation with the clinicopathological characteristics were analyzed .All patients were followed-up to find out the impact of HER3 on the disease free survival and the therapeutic effect of trastuzumab .Results The positive rate of HER3 in Luminal B ( HER2 +) and HER2-overexpressing breast cancer was 100/135 (74.1%), and 85/100(85%)respectively.The difference had statistical significance (P<0.05).The histolog-ical grading and the lymph node metastasis were significantly different in Luminal B ( HER2+) breast cancer .The tumor volume , histological grading and lymph node metastasis were significantly different in HER 2-overexpressing breast cancer .The 5-year disease free survival of HER 2-positive breast cancer patients with negative HER 3 was higher than that with positive HER3.The non-relapse survival time was not significantly different between the pos-itive and negative HER 3 expression in Luminal B ( HER2+) breast cancer patients receiving trastuzumab treat-ment , but was significantly different in HER 2-overexpressing breast cancer patients .Conclusions HER3 is cor-related with unfavourable prognosis in HER 2-positive breast cancer .The treatment targeting HER3 may improve the clinical prognosis of both HER 2-positive and HER3-positive breast cancer patients .The HER2-overexpressing breast cancer patients with negative HER 3 may benefit more from trastuzumab treatment .

Objective To observe the serum VEGF/ES ratios before and after operation and at clinical relapse in patients with breast cancer, and to discuss the potential effect of tumor surgery and postoperative relapse on the angiogenesis balance. Methods The serum VEGF and ES levels of 59 cases of breast cancer before and after operation and at clinical relapse were determined using competitive enzyme immunoassays and ELISA, (respectively), and compared with the results of 30 cases of benign breast tumors and 59 cases of normal (controls). Results (1) Preoperatively, the serum ES and VEGF levels of breast cancer patients were (significantly) elevated, as compared to the other 2 groups, and the VEGF/ES ratio was 9.1. Postoperatively, at 3 weeks, VEGF level decreased significantly and ES remained at a high level. The VEGF/ES ratio was (3.3). (2)At the time of clinical relapse, serum VEGF level was followed by marked elevation, and the VEGF/ES ratio increased up to 14.2. Multivariate analyses showed that the postoperative VEGF/ES ratio was an independent factor related to the postoperative recurrence of breast cancer. Conclusions Breast cancer surgery may affect the balance between serum VEGF and ES, and the determination of VEGF/ES ratio can have auxiliary value in the assessment of prognosis of breast cancer patients.