Leukocyte Telomere Length Variants Are Independently Associated with Survival of Patients with Colorectal Cancer

<b>Background and aims</b>: Aberrations in telomere length can have important implications in cancer. Using a cohort of 1007 patients, we investigated whether leukocyte telomere length (LTL) in patients with colorectal cancer (CRC) is associated with survival. We also investigated whether some telomere maintenance genes are associated with survival in these patients. <b>Methods:</b> The Biobank for Gastrointestinal Health Research (BGHR), an ongoing project involving collection of biospecimens at the Mayo Clinic, was utilized to obtain data from patients diagnosed with stage II or III CRC. Blood samples were collected prior to chemotherapy/radiation and DNA was extracted for measuring median LTL. The main outcome measures were overall survival (OS) and disease-free survival (DFS) by disease stage. <b>Results:</b> A significant inverse relationship was observed with patient age and LTL (spearman correlation coefficient (r) = -0.48, 95%; <i>p</i> = 1.13 × 10^-58). Females had significantly longer LTL than males (<i>p</i> = 3.97 × 10^-5). The rs1317082 SNP in the <i>TERC</i> gene was significantly associated with both OS and DFS in combined stage II and stage III patients (<i>p</i> = 0.017 and <i>p</i> = 0.023, respectively). A statistically significant association of the <i>OBFC1</i> SNP (rs9419958) was observed for OS for the combined stage II and stage III patients (<i>p</i> = 0.016). Importantly, LTL was significantly associated with both OS and DFS (<i>p</i> = 0.008 and 0.044 respectively) in combined stage II and stage III patients. <b>Conclusions:</b> Our results show that LTL is predictive of OS and DFS for stage II and III CRC patients, particularly over a longer follow-up, extending beyond five years after a diagnosis of CRC, and certain SNPs in genes involved in telomere maintenance are significantly associated with patient outcomes, independent of telomere length.