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

Table 1 Basic characteristics of included studies

Ref.	Country	Sample size	TNM stage	Detection method	Antibody	Method of quantification	Cut-off value	Positive proportion (%)	Outcome	Source of HR	Follow-up time (mo)	NOS score
Sasaki et al[11], 2009	Japan	166	I-IV	IHC	Anti-Twist (sc-15393, Santa Cruz)	Multiply percentage score and intensity score	Low: 0-5; High: 6-7	40.2	OS	R	24 (1-181)	8
Xie et al[12], 2009	China	112	I-IV	IHC	Anti-Twist (sc-15393, Santa Cruz)	Multiply percentage score and intensity score	Negative: 0-3; Positive: 4-5+; 6-8++; ≥ 9+++	79.5	OS	R	35.8 (3.4-87)	7
Lee et al[13], 2012	South Korea	165	I-IV	IHC/RT-PCR	Anti-Twist1 (ab50887, Abcam)	Intensity score	Negative: No expression; Positive: Weak, moderate, strong	50.9	OS/DFS	R/E	115 (2-155)	6
Nakajima et al[14], 2012	Japan	54	I-IVA	IHC	Anti-Twist (sc-15393, Santa Cruz)	Intensity score	Faint: 1; Moderate: 2; Strong: 3	37	OS/RFS	R	NA	7
Sun et al[15], 2013	China	164	I-III	IHC	Anti-Twist1 (ab50887, Abcam)	Percentage of stained cells	Negative: 0%-10%; Positive: > 10%	34.1	OS	E	96-120	7
Chen et al[16], 2016	China	50	NR	IHC	Anti-Twist1 (Abcam)	Percentage of stained cells	NA	50	OS	E	> 60	7
Yeo et al[17], 2017	Korea	169	I-IV	IHC	Anti-Twist1 (Abcam)	Intensity score	Negative: 1; Positive: 2-3	89.9	OS/DFS	R	NA	7
Xu et al[18], 2021	China	229	I-IV	IHC	Anti-Twist1 (ab175430; Abcam)	Multiply percentage score and intensity score	Negative: 0-5; Positive: ≥ 6	59	OS/PFS	E	NA	6
Du et al[19], 2021	China	72	I-III	IHC	Anti-Twist (bs-2441R, Bioss)	Multiply percentage score and intensity score	Negative: 0-2; Positive: ≥ 3	61.1	OS	E	14-90	6
Tang et al[20], 2021	China	40	II-IV	IHC	Anti-Twist1 (ab50581, Abcam)	Multiply percentage score and intensity score	Negative: 0-2; Positive: ≥ 3	15	OS	R	17 (13.9-20.1)	7
Wang et al[21], 2021	China	72	I-III	IHC	Anti-Twist1 (bs-2441R, Bioss)	Multiply percentage score and intensity score	Negative: 0-3; Positive: ≥ 4	61.1	OS	E	14-90	6

TNM: Tumor, node and metastasis; IHC: Immunohistochemistry; RT-PCR: Reverse transcription-polymerase chain reaction; OS: Overall survival; DFS: Disease-free survival; RFS: Relapse-free survival; PFS: Progression-free survival; HR: Hazard ratio; R: Reported; E: Estimated; NA: Not applicable; NOS: Newcastle-Ottawa quality assessment scale.

Table 2 Meta-analyses for the association of Twist expression with survival of esophageal cancer

Meta-analysis	Endpoints	HR (95%CI)	Heterogeneity test (I2)	P value	Number of studies
TWIST (+) vs TWIST (−)	OS	1.88 (1.32-2.69)a	68.6%	0.000	11
	DFS/RFS/PFS	1.84 (1.12-3.02)a	67.1%	0.028	4
Method of quantification	Multiply percentage score and intensity score	1.52 (0.87-2.65)	79.5%	0.319	6
	Intensity score	2.72 (1.84-4.03)a	0.00	0.062	9
	Percentage of stained cells	2.45 (1.43-4.19)a	68.6%	0.199	4

^aIf I² ≥ 50% and/or P < 0.1, random effects models are applied.

HR: Hazard ratio; OS: Overall survival; DFS: Disease-free survival; RFS: Relapse-free survival; PFS: Progression-free survival.

Table 3 Correlations of Twist expression with clinicopathological characteristics in esophageal cancer

Clinical features	RR (95%CI)	Heterogeneity test (I2)	P value	Number of studies
Age (≥ 60 vs < 60)	1.07 (0.95-1.21)	5.88	0.319	6
Gender (male vs female)	1.02 (0.89-1.18)a	14.85	0.062	9
Location (upper + middle vs lower)	0.89 (0.80-1.00)	4.66	0.199	4
T stage (T3 + T4 vs T1 + T2)	1.38 (1.14-1.67)a	15.30	0.018	7
Differentiation (high + moderate vs low)	0.94 (0.81-1.09)a	21.26	0.003	8
Lymph node metastasis (yes vs no)	1.34 (1.11- 1.60)a	14.99	0.036	8
Distant metastasis (yes vs no)	1.18 (1.02-1.35)a	10.74	0.030	5
TNM stage (III + IV vs I + II)	1.35 (1.14-1.60)a	13.34	0.038	7
Clinical stage (III + IV vs I + II)	1.58 (1.34-1.87)	0.39	0.534	2
Venous invasion (yes vs no)	1.46 (0.83-2.56)a	4.49	0.034	2

^aIf I² ≥ 50% and/or P < 0.1, random effects models are applied.

TNM: Tumor, node and metastasis.