Tumor lysis syndrome in lung cancer: A systematic review.

Abstract

e24044 Background: Lung cancer (LC) is the leading cause of cancer-related mortality globally. Tumor lysis syndrome (TLS), seen predominantly in hematologic malignancies, is an emerging but rare complication in lung cancer with high mortality, reaching 21% in solid tumors overall. TLS occurrence in lung cancer patients is underreported, creating a critical gap in recognition and management strategies. Objective:Identify features that distinguish LC patients at high risk for TLS and poor prognosis, and evaluate treatment outcomes to guide clinical practice. Methods: Following the PRISMA protocol, the PubMed database was queried from database inception to December 2024 using the primary search term “tumor lysis syndrome” and secondary search terms encompassing LC subtypes. Filters included English language, full text, and human species. Studies containing biochemical data and clinical courses of LC patients who developed TLS were included. Patient variables including presenting symptoms, LC stage, sites of metastasis, TLS treatments, and biochemical lab values were extracted and compared with respect to survival outcome. Results: 29 case reports featuring TLS in LC patients met inclusion criteria. Dyspnea, oliguria, or lethargy were presenting symptoms for 59% of the cohort (n=17). Mean baseline uric acid and LDH values, prior to development of TLS, were abnormally elevated (9.6, 778; SD 5.9, 521). Higher baseline LDH was significantly associated with mortality (1098 vs 458, p<.05, 95% CI 698-1498). The mortality rate for the entire cohort was 48%, and 42% among 24 treated patients. Mortality was 54% for patients with stage IV LC (n=24) and 0% for those with limited stage disease (n=4). Renal replacement therapy, symptomatic TLS, and liver metastasis were associated with 60%, 71%, and 75% mortality respectively (n=6, n=17, n=16). Only 2 patients received TLS prophylaxis; a survival benefit was not observed (100% mortality). Rasburicase was underutilized (n=5), and all non-dialysis patients who received rasburicase survived (n=3, 100%). Conclusions: This first-ever systematic review of LC patients with TLS revealed profoundly high mortality rivalling that seen in bloodborne cancers. Measures that may mitigate mortality in high-risk LC patients—those with elevated uric acid and LDH, liver metastasis or significant metastatic disease, TLS-related symptoms—include proactive initiation of urate lowering therapy and hydration, along with rasburicase and hydration for those who develop TLS. Further multicenter studies may impact current TLS diagnostic criteria, risk assessment, prophylaxis and rasburicase-use criteria to account for high-risk LC and solid tumor patients.