Objective To investigate the relationship between nucleolar spindle - associated protein 1 NuSAP1 low - density lipoprotein receptor LDLR and axillary lymph node metastasis in patients with locally advanced breast cancer and analyze the risk factors for axillary lymph node metastasis ≥ 10. Method A total of 125 patients with locally advanced breast cancer who were diagnosed and treated in our hospital from January 2018 to April 2022 were selected as the research subjects. The tumor tissues and adjacent tissues were collected during operation and the expressions of NuSAP1 mRNA and LDLR mRNA were detected. The expressions of NuSAP1 mRNA and LDLR mRNA in cancer tissues of patients with different axillary lymph node metastasis were compared. The correlation between NuSAP1 mRNA and LDLR mRNA expression and axillary lymph node metastasis was analyzed. Binary Logistic regression model was used to analyze the risk factors of axillary lymph node metastasis ≥ 10. Result The expressions of NuSAP1 mRNA and LDLR mRNA in cancer tissues were higher than those in adjacent tissues P< 0. 05 . With the increase in the number of axillary lymph node metastases the expression of NuSAP1 mRNA and LDLR mRNA in cancer tissues increased P<0. 05 . The expression of NuSAP1 mRNA and LDLR mRNA in cancer tissue was positively correlated with the number of axillary lymph node metastasis P<0. 05 . After adjusting for clinical stage and maximum tumor diameter high expression of NuSAP1 mRNA and LDLR mRNA in cancer tissue were still independent risk factors for axillary lymph node metastasis ≥ 10 in breast cancer patients P<0. 05 . Logistic regression model was established logit P = -6. 004+ 1. 298×LDLR mRNA+ 1. 141×NuSAP1 mRNA. Conclusion NuSAP1 mRNA and LDLR mRNA expressed highly in cancer tissues of patients with locally advanced breast cancer and the expression levels are closely related to the number of axillary lymph node metastases in patients.