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, 10 (7), e0133174

The Association Between Telomere Length and Cancer Prognosis: Evidence From a Meta-Analysis


The Association Between Telomere Length and Cancer Prognosis: Evidence From a Meta-Analysis

Chunli Zhang et al. PLoS One.


Background: Telomeres are essential for chromosomal integrity and stability. Shortened telomere length (TL) has been associated with risk of cancers and aging-related diseases. Several studies have explored associations between TL and cancer prognosis, but the results are conflicting.

Methods: Prospective studies on the relationship between TL and cancer survival were identified by a search of PubMed up to May 25, 2015. There were no restrictions on the cancer type or DNA source. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis approaches were conducted to determine pooled relative risks and 95% confidence intervals.

Results: Thirty-three articles containing forty-five independent studies were ultimately involved in our meta-analysis, of which twenty-seven were about overall cancer survival and eighteen were about cancer progression. Short TL was associated with increased cancer mortality risk (RR = 1.30, 95%CI: 1.06-1.59) and poor cancer progression (RR = 1.44, 95%CI: 1.10-1.88), both with high levels of heterogeneity (I2 = 83.5%, P = 0.012for overall survival and I2 = 75.4%, P = 0.008 for progression). TL was an independent predictor of overall cancer survival and progression in chronic lymphocytic leukemia. Besides, short telomeres were also associated with increased colorectal cancer mortality and decreased overall survival of esophageal cancer, but not in other cancers. Cancer progression was associated with TL in Asian and America populations and short TL predicted poor cancer survival in older populations. Compared with tumor tissue cells, TL in blood lymphocyte cells was better for prediction. In addition, the associations remained significant when restricted to studies with adjustments for age, with larger sample sizes, measuring TL using southern blotting or estimating risk effects by hazard ratios.

Conclusion: Short TL demonstrated a significant association with poor cancer survival, suggesting the potential prognostic significance of TL. Additional large well-designed studies are needed to confirm our findings.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.


Fig 1
Fig 1. Flow chart for the process of selecting eligible articles.
Fig 2
Fig 2. Forest plot for association between telomere length and cancer overall survival.
Results are presented for random effects models.
Fig 3
Fig 3. Forest plot for association between telomere length and cancer progression.
Disease-free survival, treatment-free survival, progression-free survival and relapse-free survival were involved. Results are presented for random effects models.
Fig 4
Fig 4. The association between telomere length and cancer prognosis in different cancers.
Only cancer types included at least two studies are presented.
Fig 5
Fig 5. Publication bias within cancer overall survival.

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    1. Blackburn EH. Structure and function of telomeres. Nature 1991; 350: 569–573. - PubMed
    1. Blackburn EH. Switching and signaling at the telomere. Cell 2001; 106: 661–673. - PubMed
    1. Huffman KE, Levene SD, Tesmer VM, Shay JW, Wright WE. Telomere shortening is proportional to the size of the G-rich telomeric 3'-overhang. J Biol Chem. 2000; 275: 19719–19722. - PubMed
    1. Harley CB. Telomere loss: mitotic clock or genetic time bomb? Mutat Res. 1991; 256: 271–282. - PubMed
    1. Martinez P, Blasco MA. Telomeric and extra-telomeric roles for telomerase and the telomere-binding proteins. Nat Rev Cancer 2011; 11: 161–176. 10.1038/nrc3025 - DOI - PubMed

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Grant support

This work was supported by Chinese National Natural Science Foundation Project. The grant number is 81472095, and for detail information can search on!search.action. YZ received the funding. She had a role in the study design of the manuscript.