The multivariate Cox proportional hazard analysis of these factors showed that the tumor stage (hazard ratio (HR), 3.40, 95% C.I., 2.08–5.55; P<0.001), nodal stage (HR, 3.20, 95% C.I., 1.56–5.50; P<0.001) and ER status (HR, 2.24, 95% C.I., 1.33–3.77; P = 0.002) were independent prognostic factors for metastasis-free survival in patients with axillary lymph node positive breast cancer. This evidence concerns the gene ESR1 and neoplasm.