The major targets of 5-fluorouracil (5-FU) are thymidylate synthase (TS) and methylenetetrahydrofolate reductase (MTHFR). Therefore, we hypothesized that the variable number of tandem repeat (VNTR) of the thymidylate synthase enhancer region (TSER) together with methylenetetrahydrofolate reductase (MTHFR 677C>T) polymorphism could alter drug activity and predict drug toxicity or efficacy. This study was designed to investigate the influence of TSER and MTHFR polymorphisms on the clinical outcomes of patients with colorectal cancer receiving 5-FU-based chemotherapy. Genomic DNA was isolated from 103 samples of colorectal cancer patients. The genotypes of two common polymorphisms (TSER and MTHFR 677C>T) were determined by polymerase chain reaction-restriction fragment length polymorphism. Patient prognoses were compared with genotype groups and analyzed according to tumor location and gender. There were no differences in prognosis between genotypes or functional groups when the TSER and MTHFR groups were considered separately. However, analysis of combined genotypes of the TSER and the MTHFR 677C>T polymorphisms were associated with the survival rate of colorectal cancer patients who received 5-FU-based chemotherapy (P=0.028). Prognosis of colorectal cancer patients was significantly different between proximal colon and distal colon cancers (P=0.002). However, prognosis did not receive any effect of the combined genotype when analyzed according to tumor location, such as proximal and distal colon cancer. The male group also showed a significant difference between low and high risk types of TSER and MTHFR combined genotypes when stratified according to gender (P=0.019). In conclusion, the combined TSER and MTHFR 677C>T genotypes can be potential prognostic factors in colorectal cancer with 5-FU-based chemotherapy, especially in male gender in Koreans.