Background: Colorectal cancer is one of the most common cancers worldwide. It is the result of a 
complex genetic mutations and environmental factors. TWIST1 is expressed in a wide range of normal 
and neoplastic tissues and has emerged as an important regulator of diverse functions critical in cancer 
biology including cellular transition, proliferation, metastasis and gene expression. Methods:
Immunohistochemical staining of TWIST1 was conducted on 50 tissue specimens of colorectal 
adenocarcinoma by using the avidin biotin-peroxidase complex method with diaminobenizidine 
chromagen detection system. Results: High TWIST1 expression was detected in 62% of cases. 
TWIST1 expression showed statistically significant correlation with lymph node metastasis (p= 0.007) 
and advanced tumor stage assessed by modified Dukes staging (p = 0.043). Conclusions: TWIST1
expression is significantly associated with poor prognostic factors and thus can be used as a prognostic 
indicator for colorectal carcinoma patients.