Our multivariable model for ER + /HER2- patients showed that tumor size ≥20 mm vs <20 mm (OR 2.48, 95% CI 1.19–5.29; p = 0.02), positive lymph nodes vs negative lymph nodes (OR 2.9, 95% CI 1.37–6.35; p = 0.006), and high grade tumors vs low grade (OR 3.5, 95% CI 1.64–7.70; p = 0.001) were all statistically significant predictors of distant recurrence (Fig. 4a). This evidence concerns the gene ESR1 and neoplasm.