Simple Summary Colorectal cancer risk and survival have previously been associated with telomere length in peripheral blood leukocytes and tumor tissues. We quantitatively assessed these associations through a systematic review and meta-analysis. Following PRISMA guidelines, we identified relevant studies through database searches, and performed meta-analyses using random effects models. We found no association between telomere length in circulating leukocytes and the risk of developing colorectal cancer, however, shorter leukocyte telomeres were associated with a worse survival in patients with colorectal cancer. Therefore, telomere length may serve as a potential biomarker especially for colorectal cancer prognosis. Larger prospective cohort studies are needed to further confirm this potential association. (1) Background: Colorectal cancer risk and survival have previously been associated with telomere length in peripheral blood leukocytes and tumor tissue. A systematic review and meta-analysis of the literature was conducted. The PubMed, Embase, and Web of Science databases were searched through March 2022. (2) Methods: Relevant studies were identified through database searching following PRISMA guidelines. Risk estimates were extracted from identified studies; meta-analyses were conducted using random effects models. (3) Results: Fourteen studies were identified (eight on risk; six on survival) through systematic review. While no association was observed between circulating leukocyte telomere length and the risk of colorectal cancer [overall OR (95% CI) = 1.01 (0.82-1.24)], a worse survival for those with shorter telomeres in leukocytes and longer telomeres in tumor tissues was observed [Quartile(1)/Quartile(2-4) overall HR (95% CI) = 1.41 (0.26-7.59) and 0.82 (0.69-0.98), respectively]. (4) Conclusions: Although there was no association with colorectal cancer risk, a poorer survival was observed among those with shorter leukocyte telomere length. Future larger studies evaluating a potentially non-linear relationship between telomeres and colorectal cancer are needed.
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