Association of Telomere Length with Ovarian Cancer Risk and Survival: A Systematic Review and Meta -analysis

Telomeres are protective DNA sequences at chromosome ends that shorten with cell division and regulate cellular lifespan. Dysregulation of telomere maintenance through telomerase activation is implicated in carcinogenesis, including ovarian cancer. This study aimed to systematically review and meta-analyze the association between telomere length and ovarian cancer risk and survival outcomes.

A systematic search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from inception to the final search date. Studies evaluating measured telomere length in relation to ovarian cancer risk or survival were included. Eligible observational studies reporting effect estimates were pooled using random-effects meta-analysis. Odds ratios (ORs) were synthesized for ovarian cancer risk, while hazard ratios (HRs) were pooled for survival outcomes. Heterogeneity was assessed using Cochran's Q test and the I ² statistic.

Eleven studies were included in the systematic review, of which seven were eligible for meta-analysis (four risk studies and three survival studies). For ovarian cancer risk, the pooled common-effect estimate showed a modest association (OR = 1.17; 95% confidence interval [CI]: 1.02-1.34), but this was not statistically significant under the random-effects model (OR = 1.23; 95% CI: 0.70-2.16) with moderate heterogeneity (I ² = 66.8%, P = 0.0287). For survival outcomes, the common-effect model showed no significant association between telomere length and survival (HR = 0.98; 95% CI: 0.83-1.16), with substantial heterogeneity (I ² = 85.2%, P = 0.001). The random-effects estimate also showed no significant association (HR = 1.66; 95% CI: 0.21-12.87).

Current evidence does not demonstrate a consistent association between telomere length and ovarian cancer risk or survival. Substantial heterogeneity across studies highlights the need for large, well-designed prospective studies with standardized telomere measurement methods to clarify the role of telomere dynamics in ovarian carcinogenesis.