title: Association between telomere length and the risk of colorectal cancer: a meta-analysis of observational studies.
abstract: Human chromosomes are capped and stabilized by telomeres. Telomere length regulates a 'cellular mitotic clock' that defines the number of cell divisions and hence, cellular life span. This study aimed to synthesize the evidence on the association between peripheral blood leucocytes (PBL) telomere length and the risk of colorectal cancer (CRC).
  
  
  
  We searched relevant studies in electronic databases. When two or more observational studies reported the same outcome measures, we performed pooled analysis. All the analyses were performed on PBL using PCR. The odds ratio (OR) and its 95% confidence interval (CI) were used to assess the strength of association.
  
  
  
  Seven studies (with 8 datasets) were included in this meta-analysis; 3 prospective studies, 3 retrospective studies and 1 study with a separate prospective and retrospective designs. The pooled analysis of 4 prospective studies (summary OR 1.01, 95% CI: 0.77-1.34, I2:30%) and 4 retrospective studies (summary OR 1.65, 95% CI: 0.96-2.83, I2:96%) showed no relationship between PBL telomere length and the CRC risk. A subgroup analysis of 2 prospective studies exclusively on females also showed no association between PBL telomere length and the CRC risk (summary OR, 1.17, 95% CI:0.72-1.91, I2:57%).
  
  
  
  The current analysis is insufficient to provide evidence on the relationship between PBL telomere length and the risk of CRC. Findings suggest that there may be a complex relationship between PBL telomere length and the CRC risk or discrepancy between genetics, age of patients and clinical studies. Future well powered, large prospective studies on the relationship between telomere length and the risk of CRC, and the investigations of the biologic mechanisms are recommended.
authors.affiliation: School of Postgraduate Studies, International Medical University (IMU), Kuala Lumpur, 57000, Malaysia. cho3699@gmail.com.
authors.forename: Cho
authors.initials: C
authors.lastname: Naing
authors.affiliation: School of Medicine, International Medical University (IMU), Kuala Lumpur, Malaysia.
authors.forename: Kyan
authors.initials: K
authors.lastname: Aung
authors.affiliation: School of Postgraduate Studies, International Medical University (IMU), Kuala Lumpur, 57000, Malaysia.
authors.forename: Pei Kuan
authors.initials: PK
authors.lastname: Lai
authors.affiliation: School of Postgraduate Studies, International Medical University (IMU), Kuala Lumpur, 57000, Malaysia.
authors.forename: Joon Wah
authors.initials: JW
authors.lastname: Mak
mesh_terms: D015179:Colorectal Neoplasms / Q000235:genetics*; D006801:Humans; D064887:Observational Studies as Topic; D016017:Odds Ratio; D016615:Telomere / Q000473:pathology*
keywords: Association; Colorectal cancer; Meta-analysis; Telomere