In this model, accounting for age, tumor size, nodal status, ER, PR, HER2, grade, LVI, chemotherapy and radiation, the presence of PNI remained significantly associated with LRR and the effect size was potentiated beyond that seen on univariate analysis (HR 1.57, 95% CI 1.2–2.07, p = 0.001). This evidence concerns the gene ESR1 and neoplasm.