Prognostic impact of hepatic involvement on spontaneous tumor lysis syndrome in solid tumors.

Abstract

e19098 Background: Tumor lysis syndrome (TLS) is a life-threatening oncological emergency. Spontaneous TLS (STLS) in solid tumors occurring prior to initiation of therapy is a rarely reported entity and has poor outcomes. Little is known about the prognostic factors influencing STLS in solid tumors. Methods: A systematic search of Medline, PubMed, and Embase was conducted to identify reports of patients ≥18 years diagnosed with STLS in solid tumors. Individual case reports and case series were summarized, and descriptive statistics were employed to report clinical outcomes. Fischer exact t test was used for statistical analysis. Results: 63 patients from 61 case reports and one patient from our institution resulted in a total of 64 patients. 53.1% were males with a median age of 56.1 years. The most common solid tumors were of pulmonary origin. 85.9% patients had stage 4 malignancy, 75.0% had hepatic involvement. The most common presenting symptom was abdominal discomfort. The mean serum potassium, phosphorus, uric acid, calcium, lactate dehydrogenase, and creatinine upon presentation were 6.1 mmol/l, 7.5 mg/dl, 16.4 mg/dl, 7.5 mg/dl, 4421.2 IU/L and 3.7 mg/dl, respectively. In addition to intravenous hydration, allopurinol and rasburicase were administered in 48.4% and 42.2% patients. Urinary alkalization and sodium bicarbonate administration were reported in 6.3% and 15.6% patients. 43.8% patients required hemodialysis and 39 patients died (mortality of 60.9%). Patients who underwent hemodialysis had a similar mortality of 60.4%. We assessed liver involvement (primary hepatocellular carcinoma and hepatic metastasis) as a potential prognostic factor. Compared to patients without liver involvement, patients with liver involvement had a higher unadjusted all-cause mortality (70.83% vs 25%; OR 7.29 [95% CI 1.71 - 30.98]; p = 0.006). Conclusions: Hepatic involvement is a potential prognostic factor for STLS in solid tumors and is associated with a grave prognosis. Future large prospective studies are needed to probe into the role of early hemodialysis and to identify other prognostic factors of STLS in solid tumors.

Spontaneous tumour lysis secondary to gastric adenocarcinoma

“…STLS is extremely rare in patients with solid tumours. A recent systematic review reported 64 cases of STL of solid tumours 1…”

“…Tumour-related factors include tumour type such as lymphoma, high cell turnover rate, large tumour burden, metastasis, disseminated disease, compression of the genitourinary tract by the tumour and elevated serum LDH level 2. Hepatic involvement is a strong risk factor for TLS and STL of solid tumours and predicts a poor prognosis 1 13. In a recent systematic review, 75% of the patients with STL of solid tumours showed hepatic involvement, indicating the role of hepatic involvement in the development of STLS.…”

“…In patients with STLS, rapidly proliferating tumour cells reuse the released phosphorus, unlike tumour cells, after chemotherapy; therefore, hyperphosphataemia is less common in those with STLS than in those with TLS 11 18. However, a recent systematic review of STL of solid tumours by Verghese et al reported high mean phosphate levels,1 possibly because earlier studies on STLS included many patients with haematological malignancies that have higher proliferative rates and growth kinetics than solid tumours; hence, further studies are required to determine the role of phosphate levels in STLS of solid tumours 1 2…”

“…A literature review of STLS reported that 17 out of 26 patients with solid tumours died8; another systematic review reported a mortality rate of 60.9% due to STLS in patients with solid tumours. The incidence and mortality rates of STLS in patients with solid tumours are unclear owing to the lack of large-scale studies 1. Early recognition and treatment of solid tumours are essential to improve the outcomes of patients with STLS.…”

“…TLS is commonly seen after initiation of treatment for haematological malignancies such as Burkitt’s lymphoma and acute lymphoblastic leukaemia and is rarely associated with solid tumours. Spontaneous TLS (STLS) that occurs prior to initiation of therapy is an underdiagnosed entity that is extremely rare in patients with solid tumours and is associated with poor outcomes 1. STLS of solid tumours is associated with a worse prognosis than STLS of haematological malignancies 2.…”