A meta-analysis of 5177 patients showed that high HIF-1α expression was associated with high Ki67 expression and strong VEGF expression in advanced breast cancer with lymph node metastasis positive lymph node status negative ER state ductal advanced histological grade (28).In another population-based case-control study evaluating breast cancer recurrence, HIF-1α expression may be associated with early recurrence in patients with ER-breast cancer (32).Additionally, patients with high expression of HIF may be resistant to chemotherapy and endocrine drugs, leading to treatment failure (31, 33). This evidence concerns the gene HIF1A and breast carcinoma.