Tumors with high Twist expression invaded deeper (P = 0.0044), had more lymph node metastasis (P = 0.038), had more distant nodal metastasis (P = 0.0073), had a more advanced stage (P = 0.0011) and had more lymphatic invasion (P = 0.0011) than those that were low Twist expression. Here, TWIST1 is linked to metastatic malignant neoplasm in the lymph nodes.