Twist is a transcription factor involved in the process of epithelial to mesenchymal transition (EMT) of carcinoma cells, and the promotion of invasion of gliomas through the mesenchymal adjusting process. However, its clinical significance in human glioma has not yet to be understood. To delineate the clinical-pathological significance and prognostic value of Twist, the expression of Twist was evaluated by Immunohistochemistry for 187 glioma samples. We found that Twist demonstrated frequent nuclear expression in the glioma samples and its expression levels were associated with tumor grade (P < 0.001). Furthermore, high Twist expression was correlated with a poor outcome in patients with glioma (P = 0.001), particularly with high grade glioma (P = 0.026). Interestingly, Twist expression showed positive correlation with microvascular density (MVD) (r = 0.145, P = 0.048) as well as vasculogenic mimicry (VM) (r = 0.273, P < 0.001) in the tumors. These results suggest that Twist could be a predictor for poor prognosis in glioma patients. Additionally, Twist expression was associated with two major microcirculation patterns: endothelial-dependent vessels and VM in glioma, indicating that Twist could be a potential molecular target for anti-glioma therapy. © 2020 Elsevier Inc.