Prognostic and clinicopathological value of Twist expression in esophageal cancer: A meta-analysis

Wen-Peng Song; Su-Yan Wang; Si-Cheng Zhou; Dong-Sheng Wu; Jia-Yu Xie; Tong-Tong Liu; Xiu-Zhu Wu; Guo-Wei Che

doi:10.4251/wjgo.v14.i9.1874

Prognostic and clinicopathological value of Twist expression in esophageal cancer: A meta-analysis

World J Gastrointest Oncol. 2022 Sep 15;14(9):1874-1886. doi: 10.4251/wjgo.v14.i9.1874.

Authors

Wen-Peng Song¹, Su-Yan Wang², Si-Cheng Zhou³, Dong-Sheng Wu³, Jia-Yu Xie⁴, Tong-Tong Liu⁵, Xiu-Zhu Wu³, Guo-Wei Che⁶

Affiliations

¹ Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
² Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
³ West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China.
⁴ Laboratory Experiments in Microbiology, Shuang Liu Center for Disease Control and Prevention, Chengdu 610041, Sichuan Province, China.
⁵ West China School of Public Health & West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
⁶ Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. cheguoweixw@126.com.

Abstract

Background: Twist is a repressor of E-cadherin transcription that induces epithelial-mesenchymal transition and cancer metastasis. However, the prognostic value of Twist expression in patients with esophageal cancer remains controversial.

Aim: To investigate the prognostic and clinicopathological value of Twist expression in esophageal cancer.

Methods: Published literature in databases such as EMBASE, Web of Science, PubMed, China National Knowledge Infrastructure, Wanfang, and VIP databases was searched for eligible articles. Participants with esophageal cancer whose tumor tissues underwent immunohistochemistry to detect the expression of Twist were considered. Our meta-analysis was conducted using Stata version 12.0. The hazard ratio (HR) and relative ratio (RR) with their 95%CI were pooled. Heterogeneity was estimated by I ² statistics.

Results: Eleven articles published between 2009 and 2021 fulfilled the selection criteria. The pooled HR for overall survival was 1.88 (95%CI: 1.32-2.69, I ² = 68.6%), and the pooled HR for disease-free survival/relapse-free survival/progression-free survival was 1.84 (95%CI: 1.12-3.02, I ² = 67.1%), suggesting that high Twist expression is associated with poor prognosis in esophageal cancer patients. In addition, overexpression of Twist was correlated with T stage (T3 + T4 vs T1 + T2, RR = 1.38, 95%CI: 1.14-1.67), lymph node metastasis (yes vs no, RR = 1.34, 95%CI: 1.11-1.60), distant metastasis (yes vs no, RR = 1.18, 95%CI: 1.02-1.35), tumor, node and metastasis (TNM) stage (III + IV vs I + II, RR = 1.35, 95%CI: 1.14-1.60), and clinical stage (III + IV vs I + II, RR = 1.58, 95%CI: 1.34-1.87). However, no correlation between Twist expression and age, gender, tumor location, differentiation, or venous invasion was observed.

Conclusion: High expression of Twist is associated with poor esophageal cancer prognosis. Moreover, Twist overexpression is correlated with T stage, lymph node metastasis, distant metastasis, TNM stage, and clinical stage, which indicates that Twist might accelerate esophageal cancer progression and metastasis.

Keywords: Epithelial-mesenchymal transition; Esophageal cancer; Meta-analysis; Metastasis; Prognosis; Twist.