Prognostic value of Twist in lung cancer: systematic review and meta-analysis

Background: Twist is identified as an epithelial-mesenchymal transition (EMT) regulator which has been considered to induce metastasis. However, the prognostic value of Twist in patients with lung cancer remains controversial. Methods: A search of database including EMBASE, Medline, ISI Web of knowledge and PubMed was performed. Eligible articles studying on the prognostic significance of Twist were included in this metaanalysis. Pooled hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were assessed to quantify the prognostic role. Results: A total of five studies were included. The pooled HR for Twist was 1.949 (95% CI: 1.408-2.698, I2=42.7%, P<0.001), suggesting high Twist expression is associated with poor prognosis in lung cancer patients. Our sensitivity analyses suggested the robustness of the results. Neither Begg's test nor Egger's test found publication bias in any analysis. Conclusions: Overexpressed Twist in lung cancer tissue indicated poor prognosis.