Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2022; 14(9): 1874-1886
Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1874
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
Wen-Peng Song, Guo-Wei Che, Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Su-Yan Wang, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Si-Cheng Zhou, Dong-Sheng Wu, Xiu-Zhu Wu, West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
Jia-Yu Xie, Laboratory Experiments in Microbiology, Shuang Liu Center for Disease Control and Prevention, Chengdu 610041, Sichuan Province, China
Tong-Tong Liu, West China School of Public Health & West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Song WP, Wang SY, Zhou SC and Che GW designed the research; Song WP, Zhou SC, Wu DS, Wu XZ and Xie JY conducted the literature search; Song WP and Wang SY collected and retrieved the data; Song WP, Wang SY, Wu DS, Wu XZ, Liu TT and Xie JY analyzed the data; Song WP wrote and revised the manuscript; Liu TT and Che GW contributed to editing; All authors approved the final version.
Conflict-of-interest statement: No conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Wei Che, MD, PhD, Chief Doctor, Surgeon, Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, Sichuan Province, China. cheguoweixw@126.com
Received: March 16, 2022
Peer-review started: March 16, 2022
First decision: June 12, 2022
Revised: June 30, 2022
Accepted: July 31, 2022
Article in press: July 31, 2022
Published online: September 15, 2022
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 I2 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, I2 = 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, I2 = 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: Twist, Esophageal cancer, Prognosis, Epithelial-mesenchymal transition, Metastasis, Meta-analysis

Core Tip: Esophageal cancer is a leading cause of cancer mortality worldwide. Twist is a transcription factor involved in the process of epithelial-mesenchymal transition and esophageal cancer metastasis. However, the prognostic value of Twist expression in patients with esophageal cancer remains controversial. Therefore, we conducted a meta-analysis to investigate the prognostic and clinicopathological value of Twist expression in esophageal cancer in terms of overall survival, disease-free survival/relapse-free survival/progression-free survival, age, gender, tumor location, T stage, differentiation, lymph node metastasis, distant metastasis, tumor, node and metastasis stage, clinical-stage, and venous invasion.