背景：本文主要研究Twist在鼻咽癌患者體內的表現，並更深入的去探討Twist的表現，對於鼻咽癌病患存活率的影響。
方法：本文以回溯性的方法，收集所有大林慈濟醫院裡鼻咽癌的病患共48名。以免疫染色的方法，去探討Twist在組織中的表現，與TNM分期及存活率之間的關係。並使用Pearson的卡方Fisher的精確檢驗來分析Twist、TNM分期與臨床症狀的關聯。Kaplan-Meier存活分析以及Cox比例風險模型來完整的評估存活率。Receiver operating characteristic曲線也受到審查，以驗證Twist表達能力進行預測的結果。
結果：48名鼻咽癌病患中，有19名(40%)患者發生Twist過度表現。而Twist過度表現與鼻咽癌病患脊椎前侵犯有明顯的關係(P值是0.032)。我們發現Twist過度表現對於整體的生存率有明顯的不良影響(P值是0.01)。多因素分析也顯示Twist過度表現，與生存率降低有關(hazard ratio是5,95% confidence interval是1.07-27;P值是0.041)。而receiver operating characteristic (ROC)曲線在預測結果上面也顯示Twist過度表達(area under curve是0.735)，比T的腫瘤分期(area under curve是0.718)，及臨床分期(area under curve是0.598)還要來的重要。
結論：Twist在分子生物醫學上，或許是一個很好的標記工具。對於鼻咽癌的病患，從整體的生存率上有統計學上的意義。因此，對於Twist過度表現的患者，或許應考慮給予更積極的治療計畫。

Background: The purpose of this study was to explore Twist expression in nasopharyngeal carcinoma and to investigate the prognostic impact of Twist expression on survival rates in patients with nasopharyngeal carcinoma.
Methods: We utilized Western blotting to investigate the expression of Twist, vimentin, and E-cadherin in NPC cell lines. Additionally, a retrospective review of case notes from the Dalin Tzu Chi General Hospital archives was performed. We analyzed the relationship between Twist expression of tissue specimen, TNM staging, and survival rates by using immunohistochemical staining. All nasopharyngeal carcinoma patients were included. We used Pearson’s chi-square and Fisher’s exact tests to analyze the correlation between Twist expression of tissue specimen and TNM staging and clinical features. Kaplan-Meier survival curves were constructed and survival analysis was completed using Cox proportional hazard models. Receiver operating characteristic (ROC) curve was also examined in order to validate the ability of Twist expression to predict outcomes.
Results: A total of 48 patients with newly diagnosed NPC were enrolled in this study. Nineteen patients (40%) in this series were found to have Twist overexpression. Twist overexpression in NPC patients was associated with pre-vertebral space invasion (P = 0.032). Patients with Twist overexpression were found to have a poor overall survival rate compared with others (P = 0.01, respectively), but not metastasis free-survival rate (P = 0.126). There was a trend toward significance between Twist expression and advanced T classification (P = 0.094 respectively). Multivariate analysis showed that Twist overexpression was associated with poor survival rate (hazard ratio 5, 95% confidence interval 1.07-27; P = 0.041). The receiver operating characteristic (ROC) curves for predicting outcomes revealed that Twist expression (area under curve = 0.735) was superior to T classification (area under curve = 0.718) and clinical stage (area under curve = 0.598).
Conclusions: Twist may be a useful molecular marker for nasopharyngeal carcinoma and indicator for overall survival. Patients with Twist expression should be treated more aggressively.