Furthermore, multivariate analysis revealed that the mutations remained as a significant unfavorable factor for RFS (adjusted HR 2.81; 95% CI: 1.08–7.29; P = 0.035) and DRFS (adjusted HR 3.60; 95% CI: 1.37–9.47; P = 0.009) after adjustment for age, tumor size, tumor grade, lymph node metastasis, ER, PR, HER2, and adjuvant therapy (Table 3). Here, ESR1 is linked to metastatic malignant neoplasm in the lymph nodes.