Expression of Twist enhances risk of poor oncologic outcome in patients with stage Ib to II cervical carcinoma with lymphovascular space involvement

Twist, a basic helix-loop-helix transcription factor, promotes cancer cell epithelial-mesenchymal transition and metastasis. Here, we aimed to examine the association between Twist expression and lymphovascular space involvement for early-stage cervical carcinoma. Paraffin sections from 90 patients with stage Ib to IIb cervical carcinoma were immunostained with Twist antibody, and the staining intensities were semiquantitatively evaluated. Of the 90 cervical carcinoma specimens examined in this study, 51 (56.7%) were negative for Twist and 39 (43.3%) were positive for Twist immunoreactivity. The 5-year overall survival rates of patients in the Twist-negative and Twist-positive groups were 98.0% and 75.8%, respectively. Univariate and multivariate analyses demonstrated that Twist expression was an independent prognostic factor for overall survival and recurrence-free survival (univariate: P = .0069 [overall survival], P = .0092 [recurrence-free survival]: multivariate: P = .0118 [overall survival], P = .0118 [recurrence-free survival]). On stratifying based on the negative lymphovascular space involvement status, the overall survival and recurrence-free survival of patients in the Twist-negative group was the same as that of those in the Twist-positive group (log-rank: P = .262 [recurrence-free survival], P = .899 [overall survival]). In contrast, with lymphovascular space involvement, a significantly poorer recurrence-free survival was predicted for patients in the Twist-positive group compared with that in the Twist-negative group (P = .0021). Twelve (75.0%) of 16 patients showing recurrence belonged to the Twist-positive group, and 83.3% (10/12) of them experienced recurrence in distant organs or the peritoneal cavity. This study suggested that the assessment of the Twist immunoreactivity and lymphovascular space involvement may distinguish high- from low-risk patients with locally invasive cervical carcinoma. (c) 2013 Elsevier Inc. All rights reserved.