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Meta-Analysis
. 2011;6(6):e20466.
doi: 10.1371/journal.pone.0020466. Epub 2011 Jun 10.

Shortened telomere length is associated with increased risk of cancer: a meta-analysis

Hongxia Ma  1 , Ziyuan Zhou, Sheng Wei, Zhensheng Liu, Karen A Pooley, Alison M Dunning, Ulrika Svenson, Göran Roos, H Dean Hosgood 3rd, Min Shen, Qingyi Wei
Affiliations
Meta-Analysis

Shortened telomere length is associated with increased risk of cancer: a meta-analysis

Hongxia Ma et al. PLoS One. 2011.

Abstract

Background: Telomeres play a key role in the maintenance of chromosome integrity and stability, and telomere shortening is involved in initiation and progression of malignancies. A series of epidemiological studies have examined the association between shortened telomeres and risk of cancers, but the findings remain conflicting.

Methods: A dataset composed of 11,255 cases and 13,101 controls from 21 publications was included in a meta-analysis to evaluate the association between overall cancer risk or cancer-specific risk and the relative telomere length. Heterogeneity among studies and their publication bias were further assessed by the χ(2)-based Q statistic test and Egger's test, respectively.

Results: The results showed that shorter telomeres were significantly associated with cancer risk (OR = 1.35, 95% CI = 1.14-1.60), compared with longer telomeres. In the stratified analysis by tumor type, the association remained significant in subgroups of bladder cancer (OR = 1.84, 95% CI = 1.38-2.44), lung cancer (OR = 2.39, 95% CI = 1.18-4.88), smoking-related cancers (OR = 2.25, 95% CI = 1.83-2.78), cancers in the digestive system (OR = 1.69, 95% CI = 1.53-1.87) and the urogenital system (OR = 1.73, 95% CI = 1.12-2.67). Furthermore, the results also indicated that the association between the relative telomere length and overall cancer risk was statistically significant in studies of Caucasian subjects, Asian subjects, retrospective designs, hospital-based controls and smaller sample sizes. Funnel plot and Egger's test suggested that there was no publication bias in the current meta-analysis (P = 0.532).

Conclusions: The results of this meta-analysis suggest that the presence of shortened telomeres may be a marker for susceptibility to human cancer, but single larger, well-design prospective studies are warranted to confirm these findings.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1. Flow chart for the process of selecting the final 21 publications.
Figure 2
Figure 2. Odds ratios (ORs) and 95% confidence intervals (CIs) for overall cancer risk associated with relative telomere length (shorter vs. longer, grouped by the median of telomere length ratio).
a Some controls were shared in the study by Wu et al (2003) that included a total of 313 cases and 256 controls.
Figure 3
Figure 3. Odds ratios (ORs) and 95% confidence intervals (CIs) for risk of different cancers associated with relative telomere length (shorter vs. longer, grouped by median value of telomere length ratio).
(A) Smoking-related cancers; (B) Cancers in the digestive system; (C) Cancers in the urogenital system.
Figure 4
Figure 4. Funnel plot analysis to detect publication bias.
Each point represents an independent study for the indicated association.
See this image and copyright information in PMC

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