title: Menacalc, a quantitative method of metastasis assessment, as a prognostic marker for axillary node-negative breast cancer.
abstract: BACKGROUND
  Menacalc is an immunofluorescence-based, quantitative method in which expression of the non-invasive Mena protein isoform (Mena11a) is subtracted from total Mena protein expression. Previous work has found a significant positive association between Menacalc and risk of death from breast cancer. Our goal was to determine if Menacalc could be used as an independent prognostic marker for axillary node-negative (ANN) breast cancer.
  
  
  METHODS
  Analysis of the association of Menacalc with overall survival (death from any cause) was performed for 403 ANN tumors using Kaplan Meier survival curves and the univariate Cox proportional hazards (PH) model with the log-rank or the likelihood ratio test. Cox PH models were used to estimate hazard ratios (HRs) for the association of Menacalc with risk of death after adjustment for HER2 status and clinicopathological tumor features.
  
  
  RESULTS
  High Menacalc was associated with increased risk of death from any cause (P=0.0199, HR (CI)=2.18 (1.19, 4.00)). A similarly elevated risk of death was found in the subset of the Menacalc cohort which did not receive hormone or chemotherapy (n=142) (P=0.0052, HR (CI)=3.80 (1.58, 9.97)). There was a trend toward increased risk of death with relatively high Menacalc in the HER2, basal and luminal molecular subtypes.
  
  
  CONCLUSIONS
  Menacalc may serve as an independent prognostic biomarker for the ANN breast cancer patient population.
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada. catherine.forse@mail.utoronto.ca.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Forse
authors.affiliation: Department of Pathology, Yale University School of Medicine, New Haven, CT, USA. seema.agarwal@georgetown.edu.|Department of Pathology, Georgetown University, Washington, DC, USA. seema.agarwal@georgetown.edu.
authors.forename: Seema
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. Pinnad@lunenfeld.ca.
authors.forename: Dushanthi
authors.initials: D
authors.lastname: Pinnaduwage
authors.affiliation: Department of Biology and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Massachusetts, MA, USA. fgertler@mit.edu.
authors.forename: Frank
authors.initials: F
authors.lastname: Gertler
authors.affiliation: Department of Anatomy and Structural Biology, Gruss Lupper Biophotonics Center, Integrated Imaging Program, Albert Einstein College of Medicine, New York, NY, USA. John.Condeelis@einstein.yu.edu.
authors.forename: John S
authors.initials: JS
authors.lastname: Condeelis
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA. Juan.Lin@einstein.yu.edu.
authors.forename: Juan
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA. Xianonan.Xue@einstein.yu.edu.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Xue
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA. Kimberly.Johung@yale.edu.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Johung
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada. AnnaMarie.Mulligan@uhn.ca.|Laboratory Medicine Program, University Health Network, Toronto, ON, Canada. AnnaMarie.Mulligan@uhn.ca.
authors.forename: Anna Marie
authors.initials: AM
authors.lastname: Mulligan
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA. Thomas.Rohan@einstein.yu.edu.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Rohan
authors.affiliation: Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. Bull@lunenfeld.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Bull@lunenfeld.ca.
authors.forename: Shelley B
authors.initials: SB
authors.lastname: Bull
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada. Andrulis@lunenfeld.ca.|Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. Andrulis@lunenfeld.ca.|Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada. Andrulis@lunenfeld.ca.|Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada. Andrulis@lunenfeld.ca.
authors.forename: Irene L
authors.initials: IL
authors.lastname: Andrulis
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000096:biosynthesis* / Q000235:genetics; D001943:Breast Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D053208:Kaplan-Meier Estimate; D008840:Microfilament Proteins / Q000096:biosynthesis* / Q000235:genetics; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D020033:Protein Isoforms / Q000096:biosynthesis / Q000235:genetics; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics
chemical_list: D014408:Biomarkers, Tumor; D008840:Microfilament Proteins; D020033:Protein Isoforms; D018719:Erb-b2 Receptor Tyrosine Kinases; C511939:Enah protein, human; C508053:ERBB2 protein, human