Question
A mastectomy specimen from a 42-year old female shows a 2 cm tumor which is a well differentiated ductal carcinoma of no special type with a minor in situ component. Two of 14 axillary lymph nodes are positive for metastatic tumor. The tumor is Estrogen receptor and progesterone receptor negative and Her2-neu positive. There is no distant metastasis.

Which of these tumor characteristics has the greatest effect on clinical outcome in this patient?
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