Objective: Twist, a basic helix-loop-helix transcription factor, plays a key role in the metastatic progressionof human cancer. Matrix metalloproteinase (MMP)-9 is an endopeptidase that digests basement membranetype IV collagen, therefore being possibly related to tumor progression. It has been reported that Twist andmatrix metalloproteinase-9 (MMP-9) are expressed in gastric cancers. However, the exact roles of Twist andMMP-9 in tumor metastasis and prognosis remain unclear. The aim of this study was to casts light on thisquestion. Methods:Twist and MMP-9 expression in tissue sections of 37 gastric carcinomas was evaluated withimmunohistochemistry. The staining results were compared with clinicopatholgic features and to patients’outcome. Results: Twist positive expression was significantly increased in gastric cancer cases with lymph node metastasis(P=0.023). But no correlations were found between MMP-9 overexpression and clinicopathologic features, suchas recurrence, TNM stage, and lymph node metastasis. Overall survival (OS) was significantly correlated withrecurrence, serosa invasion, TNM stages, distant metastasis, and MMP-9 (P=0.027, 0.021, 0.000, 0.024 and 0.036,respectively). Disease-free survival (DFS) was prominently related to recurrence location, serosa invasion andTNM stages (P=0.000, 0.038 and 0.003, respectively). In the Cox regression multivariate analysis, TNM stage,distant metastasis and MMP-9 were significantly associated with prognosis of gastric cancer (P=0.002, 0.019, and0.032, respectively). Conclusions: This study showed Twist positive expression to be significantly correlated withlymph node metastasis in gastric cancer. MMP-9 overexpression is associated with OS, suggesting that MMP-9is a prognostic indicator for survival in patients with gastric cancer.