title: Shorter leukocyte telomere length is independently associated with poor survival in patients with bladder cancer.
abstract: BACKGROUND
  Shorter telomere length (TL) has been reported to be associated with increased risk of early death in elder individuals. Telomere shortening has been also related to chromosomal instability, which may possibly contribute to the development of several types of digestive or urogenital system cancers and smoking-related tumors. Therefore, we investigated the impact of TL on bladder cancer survival.
  
  
  METHODS
  TL was measured in leukocyte DNA from whole peripheral blood using quantitative real-time PCR in 463 patients with bladder cancer from a total 726 cases who were followed for up to 18 years.
  
  
  RESULTS
  Patients with muscle-invasive tumor/any grade had shorter telomere than patients with non-muscle-invasive tumor/high-grade and with non-muscle-invasive tumor/non-high-grade (TL reference 0.7 ± 0.2; vs. respectively, 0.8 ± 0.2, P = 3.4 × 10(-2) and 0.8 ± 0.2, P = 3.6 × 10(-2)). Moreover, patients in the lowest quartiles of TL were associated with decreased survival after diagnosis (log-rank test, P = 3.9 × 10(-4)). A Cox regression adjusted by age, cancer aggressiveness, Bacillus Calmette-Guérin, radical cystectomy, radiotherapy, and chemotherapy showed an independent effect of TL on bladder cancer survival (HR, 3.9; 95% confidence interval, 1.7-9.1; P = 1.2 × 10(-3)).
  
  
  CONCLUSIONS
  Our results suggest that leukocyte TL is only partly related to tumor aggressiveness and that shorter telomeres act as independent prognostic predictor of survival in patients with bladder cancer. TL information may allow to better select therapeutic approaches in patients with the same stage and grade.
  
  
  CONCLUSIONS
  Blood leukocyte TL levels could provide an additional noninvasive prognostic marker to better predict survival and personalize therapies in patients with bladder cancer.
authors.affiliation: Genomic Variation in Human Population and Complex Diseases Unit, Human Genetics Foundation, Turin, Italy. Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Russo
authors.affiliation: Genomic Variation in Human Population and Complex Diseases Unit, Human Genetics Foundation, Turin, Italy. Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Modica
authors.affiliation: Genomic Variation in Human Population and Complex Diseases Unit, Human Genetics Foundation, Turin, Italy. Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Guarrera
authors.affiliation: Genomic Variation in Human Population and Complex Diseases Unit, Human Genetics Foundation, Turin, Italy. Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fiorito
authors.affiliation: Genomic Variation in Human Population and Complex Diseases Unit, Human Genetics Foundation, Turin, Italy. Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Pardini
authors.affiliation: Genomic Variation in Human Population and Complex Diseases Unit, Human Genetics Foundation, Turin, Italy. Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Viberti
authors.affiliation: Genomic Variation in Human Population and Complex Diseases Unit, Human Genetics Foundation, Turin, Italy. Department of Medical Sciences, University of Turin, Turin, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Allione
authors.affiliation: Department of Medical Sciences, University of Turin, Turin, Italy. Molecular and Epigenetic Unit, Human Genetics Foundation, Turin, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Critelli
authors.affiliation: Department of Urology, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bosio
authors.affiliation: Department of Urology, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casetta
authors.affiliation: Department of Urology, Clinica Cellini, Turin, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Cucchiarale
authors.affiliation: Department of Urology, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Destefanis
authors.affiliation: Department of Urology, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.affiliation: Department of Urology, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rolle
authors.affiliation: Department of Urology, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Zitella
authors.affiliation: Department of Urology, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Fontana
authors.affiliation: Department of Urology, Città della Salute e della Scienza, Turin, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Frea
authors.affiliation: Molecular and Epigenetic Unit, Human Genetics Foundation, Turin, Italy. Imperial College London, London, United Kingdom.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.affiliation: CPO Piemonte, Turin, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.affiliation: Genomic Variation in Human Population and Complex Diseases Unit, Human Genetics Foundation, Turin, Italy. Department of Medical Sciences, University of Turin, Turin, Italy. giuseppe.matullo@unito.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Matullo
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D016615:Telomere / Q000235:genetics* / Q000473:pathology; D059506:Telomere Shortening / Q000235:genetics*; D001749:Urinary Bladder Neoplasms / Q000235:genetics / Q000401:mortality