{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T09:08:34Z","timestamp":1773306514838,"version":"3.50.1"},"reference-count":56,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Following the establishment of the four molecular subtypes of breast cancer, additional biomarkers are required to further refine prognostication and patient stratification. Kr\u00fcppel-like factors (KLFs), components of Wnt signaling, estrogen receptor beta (ER\u03b2) isoforms, cyclin D1, and E-cadherin have been implicated in epithelial\u2013mesenchymal transition, tumor proliferation, and disease progression. In this monocentric retrospective cohort study, tissue microarrays from 153 patients with histologically confirmed breast cancer were analyzed by immunohistochemistry to assess the expression of cytoplasmic Dkk1, \u03b2-catenin, and E-cadherin, as well as nuclear cyclin D1, KLF-4, KLF-5, and ER\u03b2 isoforms, using the Remmele and Stegner immunoreactive score. Associations between protein expression patterns with clinicopathological characteristics and survival outcomes using univariable and multivariable Cox regression analyses were examined. High cytoplasmic E-cadherin expression was associated with improved overall survival [hazard ratio (HR) 0.37, 95% confidence interval (95% CI) 0.18\u20130.77, p = 0.008], whereas high nuclear expression of KLF-4 (HR 2.63, 95% CI 1.32\u20135.22, p = 0.006) and KLF-5 (HR 2.16, 95% CI 1.01\u20134.65, p = 0.048) was associated with reduced overall survival. High ER\u03b21 expression showed a marginally protective association with the development of metastases (log-rank test p = 0.045). Importantly, nuclear KLF-4 expression remained independently associated with adverse overall survival after adjustment for tumor stage, lymph node status, molecular subtype, and other molecular markers (adjusted HR 4.09, 95% CI 1.93\u20138.67, p &lt; 0.001). These findings identify nuclear KLF-4 as an adverse prognostic marker in breast cancer and support its potential relevance for molecular patient stratification.<\/jats:p>","DOI":"10.3390\/ijms27062576","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T14:43:18Z","timestamp":1773240198000},"page":"2576","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multi-Protein Profiling Reveals High Nuclear KFL-4 Expression as a Predictor of Poor Overall Survival in Breast Cancer: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-4597","authenticated-orcid":false,"given":"Mariz","family":"Kasoha","sequence":"first","affiliation":[{"name":"Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bashar","family":"Haj Hamoud","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rainer M.","family":"Bohle","sequence":"additional","affiliation":[{"name":"Institute of General and Special Pathology, University Medical School of Saarland, 66421 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Linxweiler","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphaela","family":"Bosch","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5358-2751","authenticated-orcid":false,"given":"Gilbert Georg","family":"Klamminger","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilda","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erich-Franz","family":"Solomayer","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3865-6833","authenticated-orcid":false,"given":"Meletios P.","family":"Nigdelis","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","first-page":"10","article-title":"Cancer Statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1002\/ijc.35278","article-title":"The GLOBOCAN 2022 Cancer Estimates: Data Sources, Methods, and a Snapshot of the Cancer Burden Worldwide","volume":"156","author":"Filho","year":"2025","journal-title":"Int. J. Cancer"},{"key":"ref_3","first-page":"229","article-title":"Global Cancer Statistics 2022: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.maturitas.2020.11.006","article-title":"Updates on the Treatment Invasive Breast Cancer: Quo Vadimus?","volume":"145","author":"Nigdelis","year":"2021","journal-title":"Maturitas"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.annonc.2023.11.016","article-title":"Early Breast Cancer: ESMO Clinical Practice Guideline for Diagnosis, Treatment and Follow-up*","volume":"35","author":"Loibl","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"331","DOI":"10.6004\/jnccn.2024.0035","article-title":"Breast Cancer, Version 3.2024","volume":"22","author":"Gradishar","year":"2024","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1038\/s41573-022-00579-0","article-title":"Targeting HER2-Positive Breast Cancer: Advances and Future Directions","volume":"22","author":"Swain","year":"2022","journal-title":"Nat. Rev. Drug Discov."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1056\/NEJMoa1910549","article-title":"Pembrolizumab for Early Triple-Negative Breast Cancer","volume":"382","author":"Schmid","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3987","DOI":"10.1200\/JCO.20.02514","article-title":"Abemaciclib Combined with Endocrine Therapy for the Adjuvant Treatment of HR1, HER22, Node-Positive, High-Risk, Early Breast Cancer (MonarchE)","volume":"38","author":"Johnston","year":"2020","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1056\/NEJMoa2305488","article-title":"Ribociclib plus Endocrine Therapy in Early Breast Cancer","volume":"390","author":"Slamon","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2394","DOI":"10.1056\/NEJMoa2105215","article-title":"Adjuvant Olaparib for Patients with BRCA1-or BRCA2 -Mutated Breast Cancer","volume":"384","author":"Tutt","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1055\/s-0035-1546270","article-title":"The Right Treatment for the Right Patient\u2013Personalised Treatment of Breast Cancer","volume":"75","author":"Scharl","year":"2015","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"746","DOI":"10.3332\/ecancer.2017.746","article-title":"The Past and Future of Breast Cancer Treatment-From the Papyrus to Individualised Treatment Approaches","volume":"11","author":"Ades","year":"2017","journal-title":"Ecancermedicalscience"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1056\/NEJMoa1804710","article-title":"Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer","volume":"379","author":"Sparano","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1093\/annonc\/mds334","article-title":"Endopredict Improves the Prognostic Classification Derived from Common Clinical Guidelines in ER-Positive, HER2-Negative Early Breast Cancer","volume":"24","author":"Dubsky","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100299","DOI":"10.1016\/j.jlb.2025.100299","article-title":"The Impact of Liquid Biopsy in Breast Cancer: Redefining the Landscape of Non-Invasive Precision Oncology","volume":"8","author":"Malik","year":"2025","journal-title":"J. Liq. Biopsy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"103716","DOI":"10.1016\/j.esmoop.2024.103716","article-title":"Precision Oncology in Patients with Breast Cancer: Towards a \u2018Screen and Characterize\u2019 Approach","volume":"9","author":"Rassy","year":"2024","journal-title":"ESMO Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.cell.2011.02.013","article-title":"Hallmarks of Cancer: The Next Generation","volume":"144","author":"Hanahan","year":"2011","journal-title":"Cell"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s10585-015-9750-1","article-title":"The Wnt Inhibitor Dickkopf-1: A Link between Breast Cancer and Bone Metastases","volume":"32","author":"Mariz","year":"2015","journal-title":"Clin. Exp. Metastasis"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1910","DOI":"10.1016\/j.ajpath.2018.05.003","article-title":"Re-Evaluating E-Cadherin and \u03b2-Catenin: A Pan-Cancer Proteomic Approach with an Emphasis on Breast Cancer","volume":"188","author":"Borcherding","year":"2018","journal-title":"Am. J. Pathol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.lfs.2018.08.019","article-title":"Dickkopf-1: Current Knowledge and Related Diseases","volume":"209","author":"Huang","year":"2018","journal-title":"Life Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s10585-018-9937-3","article-title":"Dickkopf-1 (Dkk1) Protein Expression in Breast Cancer with Special Reference to Bone Metastases","volume":"35","author":"Kasoha","year":"2018","journal-title":"Clin. Exp. Metastasis"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kasoha, M., Findeklee, S., Nigdelis, M.P., Schmidt, G., Solomayer, E.F., and Haj Hamoud, B. (2024). Retrospective Evaluation of Bone Turnover Markers in Serum for the Prediction of Metastases Development in Breast Cancer Patients: A Cohort Study. Biomedicines, 12.","DOI":"10.3390\/biomedicines12061201"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kasoha, M., Steinbach, A.K., Bohle, R.M., Linxweiler, B., Haj Hamoud, B., Doerk, M., Nigdelis, M.P., Stotz, L., Zimmermann, J.S.M., and Solomayer, E.F. (2024). Dkk1 as a Prognostic Marker for Neoadjuvant Chemotherapy Response in Breast Cancer Patients. Cancers, 16.","DOI":"10.3390\/cancers16020419"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1038\/nrc3582","article-title":"Kr\u00fcppel-like Factors in Cancer","volume":"13","author":"Tetreault","year":"2013","journal-title":"Nat. Rev. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2709","DOI":"10.1158\/1078-0432.CCR-03-0484","article-title":"Nuclear Localization of KLF4 Is Associated with an Aggressive Phenotype in Early-Stage Breast Cancer","volume":"10","author":"Pandya","year":"2004","journal-title":"Clin. Cancer Res."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Treeck, O., Sch\u00fcler-Toprak, S., and Ortmann, O. (2020). Estrogen Actions in Triple-Negative Breast Cancer. Cells, 9.","DOI":"10.3390\/cells9112358"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1158\/0008-5472.CAN-03-2446","article-title":"Estrogen Receptor \u03b2 Inhibits Human Breast Cancer Cell Proliferation and Tumor Formation by Causing a G2 Cell Cycle Arrest","volume":"64","author":"Paruthiyil","year":"2004","journal-title":"Cancer Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Sellitto, A., D\u2019agostino, Y., Alexandrova, E., Lamberti, J., Pecoraro, G., Memoli, D., Rocco, D., Coviello, E., Giurato, G., and Nassa, G. (2020). Insights into the Role of Estrogen Receptor \u03b2 in Triple-Negative Breast Cancer. Cancers, 12.","DOI":"10.3390\/cancers12061477"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Takano, E.A., Younes, M.M., Meehan, K., Spalding, L., Yan, M., Allan, P., Fox, S.B., Redfern, A., Clouston, D., and Giles, G.G. (2023). Estrogen Receptor Beta Expression in Triple Negative Breast Cancers Is Not Associated with Recurrence or Survival. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-10795-5"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"56876","DOI":"10.18632\/oncotarget.10871","article-title":"Fulvestrant Inhibits Growth of Triple Negative Breast Cancer and Synergizes with Tamoxifen in ER\u03b1 Positive Breast Cancer by Up-Regulation of ER\u03b2","volume":"7","author":"Mishra","year":"2016","journal-title":"Oncotarget"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"E3673","DOI":"10.1073\/pnas.1803291115","article-title":"Pharmacological Activation of Estrogen Receptor Beta Augments Innate Immunity to Suppress Cancer Metastasis","volume":"115","author":"Zhao","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4769","DOI":"10.1038\/s41388-018-0304-2","article-title":"E-Cadherin in Contact Inhibition and Cancer","volume":"37","author":"Mendonsa","year":"2018","journal-title":"Oncogene"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"6574","DOI":"10.1038\/s41598-018-23733-4","article-title":"E-Cadherin Breast Tumor Expression, Risk Factors and Survival: Pooled Analysis of 5,933 Cases from 12 Studies in the Breast Cancer Association Consortium","volume":"8","author":"Horne","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1007\/s00404-021-06198-1","article-title":"The Role of E-Cadherin Expression in Primary Site of Breast Cancer","volume":"305","author":"Karsten","year":"2022","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"10434","DOI":"10.1038\/s41598-023-37012-4","article-title":"Association of Quantitative Analysis of Intratumoral Reduced E-Cadherin Expression with Lymph Node Metastasis and Prognosis in Patients with Breast Cancer","volume":"13","author":"Meng","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_37","first-page":"1659","article-title":"Significance and Prognosis of Epithelial-Cadherin Expression in Invasive Breast Carcinoma","volume":"16","author":"Yang","year":"2018","journal-title":"Oncol. Lett."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s12262-020-02576-2","article-title":"Immunohistochemical E-Cadherin Expression and Response to Chemotherapy in Breast Cancer Subjects","volume":"83","author":"Korpal","year":"2021","journal-title":"Indian. J. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"29","DOI":"10.18632\/oncotarget.1456","article-title":"Kr\u00fcppel-like Factors in Cancer Progression: Three Fingers on the Steering Wheel","volume":"5","author":"Limame","year":"2013","journal-title":"Oncotarget"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1038\/ncb1314","article-title":"The KLF4 Tumour Suppressor Is a Transcriptional Repressor of P53 That Acts as a Context-Dependent Oncogene","volume":"7","author":"Rowland","year":"2005","journal-title":"Nat. Cell Biol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1038\/onc.2010.591","article-title":"Kruppel-like Factor 4 (KLF4) Is Required for Maintenance of Breast Cancer Stem Cells and for Cell Migration and Invasion","volume":"30","author":"Yu","year":"2011","journal-title":"Oncogene"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"23808","DOI":"10.1074\/jbc.M111.236737","article-title":"Kr\u00fcppel-like Factor 4 (KLF4) Activates the Transcription of the Gene for the Platelet Isoform of Phosphofructokinase (PFKP) in Breast Cancer","volume":"286","author":"Moon","year":"2011","journal-title":"J. Biol. Chem."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1038\/s41420-023-01416-y","article-title":"KLF4 Transcription Factor in Tumorigenesis","volume":"9","author":"He","year":"2023","journal-title":"Cell Death Discov."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1111\/cas.14910","article-title":"The Roles and Regulation of the KLF5 Transcription Factor in Cancers","volume":"112","author":"Luo","year":"2021","journal-title":"Cancer Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s13058-020-01305-7","article-title":"KLF4 Defines the Efficacy of the Epidermal Growth Factor Receptor Inhibitor, Erlotinib, in Triple-Negative Breast Cancer Cells by Repressing the EGFR Gene","volume":"22","author":"Roberts","year":"2020","journal-title":"Breast Cancer Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e1699","DOI":"10.1038\/cddis.2015.65","article-title":"Regulation of Anti-Apoptotic Signaling by Kruppel-like Factors 4 and 5 Mediates Lapatinib Resistance in Breast Cancer","volume":"6","author":"Farrugia","year":"2015","journal-title":"Cell Death Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1007\/s12282-016-0708-1","article-title":"KLF4 and NANOG Are Prognostic Biomarkers for Triple-Negative Breast Cancer","volume":"24","author":"Nagata","year":"2017","journal-title":"Breast Cancer"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Subbalakshmi, A.R., Sahoo, S., McMullen, I., Saxena, A.N., Venugopal, S.K., Somarelli, J.A., and Jolly, M.K. (2021). Klf4 Induces Mesenchymal\u2013Epithelial Transition (MET) by Suppressing Multiple Emt-inducing Transcription Factors. Cancers, 13.","DOI":"10.1101\/2021.08.26.457621"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12935-022-02449-6","article-title":"The Functions and Prognostic Value of Kr\u00fcppel-like Factors in Breast Cancer","volume":"22","author":"Zhu","year":"2022","journal-title":"Cancer Cell Int."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1530\/ERC-12-0017","article-title":"Kr\u00fcppel-like Factor 5 in Human Breast Carcinoma: A Potent Prognostic Factor Induced by Androgens","volume":"19","author":"Takagi","year":"2012","journal-title":"Endocr. Relat. Cancer"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.2147\/OTT.S68340","article-title":"The Transcription Factor KLF4 as an Independent Predictive Marker for Pathologic Complete Remission in Breast Cancer Neoadjuvant Chemotherapy: A Case-Control Study","volume":"7","author":"Dong","year":"2014","journal-title":"Onco. Targets. Ther."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1007\/s10637-015-0273-z","article-title":"Phase 1 Study of APTO-253 HCl, an Inducer of KLF4, in Patients with Advanced or Metastatic Solid Tumors","volume":"33","author":"Cercek","year":"2015","journal-title":"Invest. New Drugs"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Nakajima, W., Miyazaki, K., Asano, Y., Kubota, S., and Tanaka, N. (2021). Kr\u00fcppel-like Factor 4 and Its Activator Apto-253 Induce Noxa-Mediated, P53-Independent Apoptosis in Triple-Negative Breast Cancer Cells. Genes, 12.","DOI":"10.3390\/genes12040539"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e14288","DOI":"10.1111\/jep.14288","article-title":"Association Does Not Mean Causation, When Observational Data Were Misinterpreted as Causal: The Observational Interpretation Fallacy","volume":"31","author":"Marmiere","year":"2025","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1055\/s-2007-1022338","article-title":"[Histologic Regression of Breast Cancer after Primary (Neoadjuvant) Chemotherapy]","volume":"54","author":"Sinn","year":"1994","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref_56","first-page":"138","article-title":"Recommendation for Uniform Definition of an Immunoreactive Score (IRS) for Immunohistochemical Estrogen Receptor Detection (ER-ICA) in Breast Cancer Tissue","volume":"8","author":"Remmele","year":"1987","journal-title":"Pathologe"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/6\/2576\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T14:44:15Z","timestamp":1773240255000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/6\/2576"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":56,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["ijms27062576"],"URL":"https:\/\/doi.org\/10.3390\/ijms27062576","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]}}}