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Objective To investigate the expressions of Twist transcription factor and E-cadherin in anaplastic thyroid carcinoma and their correlation with the prognosis. Methods The clinicopathological data of 20 patients with anaplastic thyroid carcinoma in Shanxi Provincial Cancer Hospital from May 2016 to April 2018 were retrospectively analyzed. The expressions of Twist protein and E-cadherin protein in anaplastic thyroid carcinoma tissues and corresponding paracancerous tissues were detected by using immunohistochemistry. The relationship between the expressions of the two proteins and the clinicopathological features of the patients was analyzed, and the correlation among the expressions of the two proteins as well as the clinicopathological factors and the prognosis of the patients was analyzed. Results The positive expression rate of Twist protein in anaplastic thyroid carcinoma tissues was 65％ (13/20), while it was 20％ (4/20) in paracancerous tissues, and the difference was statistically significant (P= 0.004). The positive expression rate of E-cadherin in anaplastic thyroid carcinoma tissues was 60％(12/20), while it was 100％(20/20) in paracancerous tissues, and the difference was statistically significant (P = 0.001). There was a negative correlation between the expression of Twist protein and E-cadherin protein in anaplastic thyroid carcinoma (r=-0.685, P=0.001). The expression of Twist protein in anaplastic thyroid carcinoma was correlated with lymph node metastasis and TNM stage (both P< 0.05), while it had no correlation with gender, age and tumor diameter (all P> 0.05). The expression of E-cadherin protein in anaplastic thyroid carcinoma had no correlation with clinicopathological factors (all P> 0.05). The results of Kaplan-Meier survival analysis showed that lymphnode metastasis (P< 0.01), TNM stage (P = 0.002) and the expression of Twist protein (P = 0.017) were prognostic factors in patients with anaplastic thyroid carcinoma. Conclusions The expression of Twist transcription factor is upregulated in anaplastic thyroid carcinoma, and the expression of E-cadherin is downregulated. The expression of Twist protein is correlated with the prognosis of the patients. The epithelial-mesenchymal transition may be involved in the progress of anaplastic thyroid carcinoma.