Multivariable logistic regression, relating tumor size, nodal status, tumor grade, systemic therapy, ER, HER, and αB-crystallin to the development of brain metastasis as the first site of distant relapse found that αB-crystallin status was the only independent predictor for brain metastasis as the first site of distant relapse (odds ratio=3.15 (95% CI 1.43–6.95), P=0.005). This evidence concerns the gene ESR1 and neoplasm.