The results of the present study show that high ATF4 expression was associated with poorer overall survival and relapse-free survival in breast cancer patients (Figure 3), that ATF4 was activated in hypoxic metM-Wntlung cells, and contributed to viability of hypoxic metM-Wntlung cells in adherent and detached conditions (Figure 4). This evidence concerns the gene ATF4 and breast carcinoma.