A significant adverse effect of TWIST1 expression was found and related to higher tumor grade (p = 0.0229), more advanced pT classification (p = 0.0044), lymph node metastasis (p = 0.0301), lymphatic vessel invasion (p = 0.0373), frequent perineural invasion (p = 0.0109) and significantly worse overall time (p = 0.0226; Figure 4). This evidence concerns the gene TWIST1 and metastatic malignant neoplasm in the lymph nodes.