Tumor lysis syndrome in colorectal cancer: A systematic review of clinical characteristics.

Abstract

122 Background: Tumor lysis syndrome (TLS) is an oncologic emergency resulting from the release of potassium, phosphorus, and nucleic acids from tumor cells. While rare in colorectal cancer (CRC), TLS is linked with high mortality, and literature is limited. This study aims to summarize the clinical characteristics of patients with TLS in CRC. Methods: We conducted a systematic review of TLS in CRC through a comprehensive literature search in PubMed and manual searches from January 1st, 1993, up to September 13th, 2024. Keywords included "Tumor Lysis Syndrome," "Colorectal Cancer," and "Colon Cancer." 32 studies were found, identifying 11 spontaneous and 22 therapy-related TLS cases. Quantitative and qualitative data were extracted for descriptive analysis. Results: A total of 33 patients (16 males and 15 females) had a mean age of 56.5 ± 17.8 years at TLS diagnosis. The mean ages for males and females were 58.3 ± 7.1 and 55.8 ± 13.7 years, respectively (p=0.59). The primary histology was adenocarcinoma (92%) followed by neuroendocrine (8%) (data unavailable for 9 patients). Among 15 patients with grading information, Grade 2 tumors were most common (53%), followed by Grade 3 (40%) and Grade 1 (7%). Staging data was available for 32 patients. Most patients had Stage IV disease (94%), with frequent metastases to the liver (93%), lungs (30%), and bones (10%). Hyperuricemia is present in all patients (1 patient without data). Acute kidney injury (AKI) was present in all patients (4 patients without data). Hyperphosphatemia was found in 82% of patients (5 patients without data). Hypocalcemia was noted in 52% (10 patients without data), and hyperkalemia was found in 74% (6 patients without data). Out of the 33 patients, 11 experienced spontaneous TLS (33%) and 22 had therapy-related TLS (67%). Duration of TLS onset following therapy was available for 17 patients, including one outlier at 30 days on Capecitabine. The mean duration for therapy-related TLS, excluding the outlier, was 3.8 ± 2.5 days. Among the 22 patients on therapy, 59% received 5-Fluorouracil (5-FU)-based treatment. 31% of those receiving 5-FU had combination therapy with Bevacizumab. Death occurred in 59% of patients, with data missing for 4 patients. Conclusions: TLS in colorectal cancer (CRC) is associated with a mortality rate of up to 59% and shows no gender preference. Identifying predictive factors is crucial for TLS prophylaxis. Patients with TLS in CRC often present with Stage IV disease, liver metastasis, hyperuricemia, and acute kidney injury (AKI).