Overexpression of Twist and Matrix Metalloproteinase-9 with Metastasis and Prognosis in Gastric Cancer

  • Gao, Xing-Hui (Department of Laboratory Medicine & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University) ;
  • Yang, Xue-Qin (Medical School of Jingchu University of Technology) ;
  • Wang, Bi-Cheng (Department of Laboratory Medicine & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University) ;
  • Liu, Shao-Ping (Hubei Key Laboratory of Tumor Biological Behaviors & Hubei Cancer Clinical Study Center) ;
  • Wang, Fu-Bing (Department of Laboratory Medicine & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University)
  • Published : 2013.09.30


Objective: Twist, a basic helix-loop-helix transcription factor, plays a key role in the metastatic progression of human cancer. Matrix metalloproteinase (MMP)-9 is an endopeptidase that digests basement membrane type IV collagen, therefore being possibly related to tumor progression. It has been reported that Twist and matrix metalloproteinase-9 (MMP-9) are expressed in gastric cancers. However, the exact roles of Twist and MMP-9 in tumor metastasis and prognosis remain unclear. The aim of this study was to casts light on this question. Methods:Twist and MMP-9 expression in tissue sections of 37 gastric carcinomas was evaluated with immunohistochemistry. The staining results were compared with clinicopatholgic features and to patients' outcome. Results: Twist positive expression was significantly increased in gastric cancer cases with lymph node metastasis (P=0.023). But no correlations were found between MMP-9 overexpression and clinicopathologic features, such as recurrence, TNM stage, and lymph node metastasis. Overall survival (OS) was significantly correlated with recurrence, serosa invasion, TNM stages, distant metastasis, and MMP-9 (P=0.027, 0.021, 0.000, 0.024 and 0.036, respectively). Disease-free survival (DFS) was prominently related to recurrence location, serosa invasion and TNM stages (P=0.000, 0.038 and 0.003, respectively). In the Cox regression multivariate analysis, TNM stage, distant metastasis and MMP-9 were significantly associated with prognosis of gastric cancer (P=0.002, 0.019, and 0.032, respectively). Conclusions: This study showed Twist positive expression to be significantly correlated with lymph node metastasis in gastric cancer. MMP-9 overexpression is associated with OS, suggesting that MMP-9 is a prognostic indicator for survival in patients with gastric cancer.


Gastric cancer;twist;matrix metalloproteinase-9;prognosis;survival


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