In the PSM cohort, detailed subgroup analyses indicated the high-HALP group was associated with improved OS within specific subgroups, including patients under 60 years, those with invasive ductal carcinoma, those with no hypertension and diabetes, ER-negative, PR-negative, HER-2 negative, Ki-67 ≥ 14%, those not receiving targeted therapy, CEA negative, and those with high PLR, when adjustments were made for other covariates (Fig. 6). The gene discussed is ESR1; the disease is diabetes mellitus.