Is overexpression of TWIST, a transcriptional factor, a prognostic biomarker of head and neck carcinoma? Evidence from fifteen studies.

TWIST, a basic helix-loop-helix transcription factor, has been indicated to play a critical role in the progression of numerous malignant disorders. Published data on the significance of TWIST expression in head and neck carcinoma (HNC) risk have yielded conflicting results. Thus, we conducted a quantitative meta-analysis to obtain a precise estimate of this subject. After systematic searching and screening, a total of fifteen studies using immunohistochemistry for TWIST detection were included. The results showed that TWIST positive expression rate in HNC tissues was higher than that in normal tissues. TWIST expression might have a correlation with clinical features such as low differentiation, advanced clinical stage, presence of lymph node metastasis, distant metastasis and local recurrence (P < 0.05) , but not with age, gender, T stage and smoking as well as drinking (P > 0.05). In addition, over-expression of TWIST was a prognostic factor for HNC (HR = 1.92, 95% CI = 1.13-3.25). The data suggested that TWIST might play critical roles in cancer progression and act as a prognostic factor for HNC patients.