Abbreviations: BC, breast cancer; BCSS, breast cancer-specific survival; CI, confidence interval; HMGB1, high mobility group box 1; HR, hazard ratio; LC3B (MAP1LC3B/LC3B), microtubule-associated protein 1 light chain 3B; MFS, metastasis free survival; OS, overall survival; PBS, phosphate-buffered saline; SQSTM1/p62, sequestosome 1; TLR4, toll-like receptor 4; TMAs, tissue microarrays.In spite of adjuvant chemotherapy, a significant fraction of patients with localized breast cancer (BC) relapse after optimal treatment. We determined the occurrence of cytoplasmic MAP1LC3B/LC3B (microtubule-associated protein 1 light chain 3B)-positive puncta, as well as the presence of nuclear HMGB1 (high mobility group box 1) in cancer cells within surgical BC specimens by immunohistochemistry, first in a test cohort (152 patients) and then in a validation cohort of localized BC patients who all received adjuvant anthracycline-based chemotherapy (1646 patients). Cytoplasmic LC3BC puncta inversely correlated with the intensity of SQSTM1 staining, suggesting that a high percentage cells of LC3B C puncta reflects increased autophagic flux. After setting optimal thresholds in the test cohort, cytoplasmic LC3BC puncta and nuclear HMGB1 were scored as positive in 27.2% and 28.6% of the tumors, respectively, in the validation cohort, while 8.7% were considered as double positive. LC3BC puncta or HMGB1 expression alone did not constitute independent prognostic factors for metastasis-free survival (MFS) in multivariate analyses. However, the combined positivity for LC3B C puncta and nuclear HMGB1 constituted an independent prognostic factor significantly associated with prolonged MFS (hazard ratio: 0.49 95% confidence interval [0.26-0.89]; P D 0.02), and improved breast cancer specific survival (hazard ratio: 0.21 95% confidence interval [0.05-0.85]; P D 0.029). Subgroup analyses revealed that within patients with poor-prognosis BC, HMGB1 C LC3B C double-positive tumors had a better prognosis than BC that lacked one or both of these markers. Altogether, these results suggest that the combined positivity for LC3B C puncta and nuclear HMGB1 is a positive predictor for longer BC survival.