title: The Role of TWIST in Ovarian Epithelial Cancers.
abstract: BACKGROUND
  Epithelial-mesenchymal transition (EMT) is associated with tumor hypoxia. EMT is regulated, in part, by the action of TWIST, which inhibits of E-cadherin expression and may interfere with the p53 tumor-suppressor pathway.
  
  
  METHODS
  We examined the expression of TWIST, E-cadherin, hypoxia-inducible factor 1α (HIF1α), and p53 by immunohistochemistry in 123 cases of ovarian epithelial cancers (OEC) to evaluate the role of TWIST in OEC. We assessed the association between protein expression and clinicopathologic parameters.
  
  
  RESULTS
  The expression of TWIST, E-cadherin, HIF1α, and p53 proteins was found in 28.5%, 51.2%, 35.0%, and 29.3% of cases, respectively. TWIST expression was associated with higher histologic grade and unfavorable survival. TWIST expression was correlated with HIF1α expression and reduced E-cadherin expression. The altered HIF1α/TWIST/E-cadherin pathway was associated with lower overall survival (OS), while the co-expression of TWIST and p53 was correlated with lower progression-free survival. In the multivariate analyses, TWIST expression was an independent prognostic factor for OS.
  
  
  CONCLUSIONS
  Our data imply that TWIST expression could be a useful predictor of unfavorable prognosis for OEC. TWIST may affect the p53 tumor-suppressor pathway. Moreover, hypoxia-mediated EMT, which involves the HIF1α/TWIST/E-cadherin pathway may play an important role in the progression of OEC.
authors.affiliation: Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Kyungbin
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Pathology, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Park
authors.affiliation: Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Man Soo
authors.initials: MS
authors.lastname: Yoon
authors.affiliation: Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Suh
authors.affiliation: Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Ki Hyung
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea. ; Department of Pathology, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea. ; Department of Pathology, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Jee Yeon
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea. ; Department of Pathology, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Mee Young
authors.initials: MY
authors.lastname: Sol
authors.affiliation: Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea. ; Department of Pathology, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Kyung Un
authors.initials: KU
authors.lastname: Choi
keywords: Cadherins; HIF1α; Ovarian epithelial cancer; TWIST transcription factor; Tumor suppressor protein p53