Runx2 has been proposed as one of the pivotal factors in the process of osteogenesis and metastasis in human malignancies including breast cancer, but its details have not been evaluated. Therefore, in this study, we evaluated its expression in human breast cancer using immunohistochemistry. One hundred and thirty-seven formalin-fixed and paraffin-embedded breast cancer specimens were used in this analysis of immunohistochemical study. Immunoreactivity was evaluated using the labeling index (LI). Runx2 immunoreactivity was detected in both carcinoma and stromal cells, as well as non-pathological ductal cells. The nuclear LI of Runx2 in carcinoma cells was associated with the clinical stage, histological grade and HER2 status of the patients examined. In addition, among the patients not associated with distant metastasis, those with high Runx2 LI demonstrated a significantly worse clinical outcome than those with a low LI. This was more pronounced in the group of estrogen receptor (ER)-negative cases. In addition, both univariate and multivariate analyses demonstrated that the Runx2 LI in breast carcinoma cells turned out an independent prognostic factor. Results of our present study demonstrated that Runx2 plays very important roles in the progression of breast cancer, especially in those of ER-negative cases. (Cancer Sci 2010; 101: 2670-2675 B reast cancer is one of the most common malignancies in women worldwide. Recently, the potential association of breast cancer with its bone metastasis has been evaluated from different perspectives and, in particular, the process of osteolysis itself in its metastatic sites has been proposed to facilitate breast cancer progression.(1) It is also well known that breast carcinoma cells themselves secrete parathyroid-hormone-related peptide (PTHrP), which stimulates osteoblasts in the microenvironment of bone metastatis.(2) Osteoblasts at the sites of metastasis are also considered to secrete a receptor activator of NFjB ligand (RANKL) to facilitate the process of transition from mesenchymal cells into functional osteoclasts, which subsequently resorb bone.(3-7) In normal human adult skeleton, bone is constantly renewed or maintained through the coordinated activities of both osteoclasts and osteoblasts.(8) Metastatic breast carcinoma cells are seeded into the bone microenvironment, which results in the maturation of osteoclasts.(9) These subsequently formed osteolytic foci are associated with bone resorption, which eventually leads to the release of growth factors including transforming growth factor-b (TGF-b) and several insulin-like growth factors (IGF) from the collapsed bone matrix.(10,11) These factors are considered to subsequently mediate tumor cell proliferation at the sites of bone metastasis.The Runt-related transcription factors 1-3 (Runxs1-3) have been shown to be required for the process of organogenesis, and mutations in these genes have been reported to be linked to several types of cancer development.(12) For instance, Runx1 and Runx3 mutations were reported...