Clinical features and outcomes of tumor lysis syndrome in patients with gastrointestinal cancers.

Abstract

655 Background: In recent years, tumor lysis syndrome (TLS), an oncologic emergency typically associated with cytotoxic therapies, has been increasingly reported across a spectrum of cancer types including GI cancers. The objective of this study was to investigate the clinical characteristics and outcomes of TLS in GI cancers. Methods: Systematic review of the literature and pooled analysis of published cases of TLS in solid tumors. Two additional cases treated in our intuition are also included. Results: A total of 246 patients with TLS in solid tumors were included in this study. The median age was 56 years (7 months -94 years). The male: female ratio was 1.3. The most common sites were gastrointestinal (29%), followed by genitourinary (24%), lung (12%), melanoma (10%), breast cancer (8.1%), and GYN tumors (7.8%). Liver metastasis was documented in 70% of patients. TLS occurred after various cancer-directed therapies in 69% of subjects, and spontaneously in 31% of subjects. Older age and liver metastasis predict high mortality. The clinical features, treatment, and outcomes of TLS in 74 cases of GI cancers including HCC (n = 27), colorectal (n = 22), gastric (n = 8), cholangiocarcinoma (n = 6), pancreatic cancer (n = 4), GIST (n = 3), and PNET (n = 2) were compared. The mortality rate of TLS in this cohort was 100% in pancreases and cholangiocarcinoma, 66.7% in GIST, 57.7% in HCC, 54.5% in CRC, 50% in Gastric cancer. Conclusions: Documented across different sites consistently, TLS in GI cancers is associated with very high mortality. The development of a wider range of novel therapies and the application of more intensive therapy for the treatment of GI cancers likely contributed to the increased risk of TLS.[Table: see text]