Interestingly, using the comparison scoring system N> = C or C>N as previously described [16], the N> = C FOXO3a staining of all cases irrespective of histological types was positively associated with the P-Akt staining (p = 0.039, Chi-square test), suggesting uncoupling of the Akt-FOXO3a signaling axis is associated with lymph node metastasis and poor survival in invasive ductal carcinoma. This evidence concerns the gene FOXO3 and invasive ductal breast carcinoma.