Abstract: Objective:To investigate the effect of Twist, β-catenin and E-cadherin on the recurrence and metastasis of hepatocellular carcinoma (HCC) and its correlation with clinical prognosis. Methods:Immunohistochemical staining (SP) was conducted to detect the expression of Twist, β-catenin and E-cadherin in 97hepatocellular carcinoma patients ( 49with recurrence and metastasis and 48without recurrence and metastasis). Results: The recurrence and metastasis of HCC were correlated with clinical stage (P=0.000 ), but were not correlated with sex or age (P= 0.424 , P= 0.738 ). The abnormal expression of Twist and β-catenin in the recurrence and metastasis group was higher than that in the group wi thout recur-rence or metastasis ( P=0.000 , P=0.000 ). The positive ratio of E-cadherin in the recurrence and metastasis group was lower than that in the group without recurrence or metastasis ( P=0.027 ). The mean survival was 28.880 ± 3.285 months in patients with positive expression of Twist and 31.477 ± 3.359 months in patients wi th posi tive expression of β-catenin. The median survival time of them was 26and 28months, respctively. The mean survival was 44.603 ± 3.521 months in patients without Twist expression and 42.009 ± 3.720 months in patients wi thout β-catenin expression. The median survival time of them was 49 and 45months, respectively. The survival of patients wi th posi tive expression of Twist and β-catenin was shorter than that in patients wi thout expression of Twist and β-catenin (P=0.002 , P=0.029 ). The mean survival time and median survival time of patients wi th Twist and β-catenin expression were 44.514 ± 3.447 months and 49 months, respectively, significantly higher than those in patients wi thout Twist and β-catenin expression (P=0.002 ), which were 29.110 ± 3.581 months and 25 months, respectively. Conclusion:The overexpression of Twist and β-catenin as wel l as decreased expression of E-cad-herin may play critical roles in the recurrence and metastasis of HCC and indicate poor prognosis.