Liver metastasis as an independent predictor for mortality in patients who developed tumor lysis syndrome: Analysis of 132 patients with solid tumors.

Harmon, Jonathan; Allen, Sarah; Cassaday, Jill; Ruvinov, Kirill; Stoyanova, Desi; Tadipatri, Ramya; Ross, Malcolm S.; Raj, Jaya; Wang, Jue

doi:10.1200/jco.2018.36.15_suppl.e18766

Cited by 6 publications

(16 citation statements)

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“…Lack of awareness about the risk of TLS in RCC, delayed diagnosis, and suboptimal management likely contribute to the higher mortality in this population. Education efforts are urgently needed to increase the awareness for this rare but potentially life-threatening oncologic emergency [3][4]. The most important finding from our study is that TLS associated with RCC occurs later than previously expected: the median time from treatment to TLS was 16 days with a range of 14 to 28 days.…”

Section: Discussionmentioning

confidence: 68%

“…However, our recent study shows significant increase in cases of TLS associated with solid tumors [4]. TLS occurs in essentially every tumor type, such that the tumor burden itself is likely the more important factor than the tissue origin or location [3][4][5][6][7]. High tumor burden has classically been defined via three concrete measurements: bulky disease (>10 cm), elevated LDH (>2x upper limit of normal), and elevated WBC (>25,000) [9].…”

Section: Discussionmentioning

confidence: 79%

“…Though well-documented in hematological malignancies, TLS was considered relatively rare in solid tumors in the era when the effective treatment was not available. However, our recent study shows significant increase in cases of TLS associated with solid tumors [4]. TLS occurs in essentially every tumor type, such that the tumor burden itself is likely the more important factor than the tissue origin or location [3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…RCC is the most common solid lesion of the kidney, and more than 40% of patients eventually die from this disease. Although the true incidence of TLS in RCC is difficult to assess, we postulate that TLS in RCC may be underdiagnosed and underreported [3][4][5][6][7]. Several studies showed that a substantial proportion of TLS cases presenting to the emergency department (ED) were not recognized as such.…”

Section: Discussionmentioning

confidence: 99%

“…The most important finding from our study is that TLS associated with RCC occurs later than previously expected: the median time from treatment to TLS was 16 days with a range of 14 to 28 days. This finding is particularly important because it is outside the usual timeframe that is observed with conventional chemotherapy in routine clinical setting [4][5][6][7]. The current guidelines and consensus on diagnosis and management of TLS were based on pediatric hematologic tumors and established more than one decade ago [8][9].…”

Section: Discussionmentioning

confidence: 99%

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Tumor lysis syndrome associated with renal cell carcinoma

2019

Int Med

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Background: Tumor lysis syndrome (TLS) is an oncologic emergency which has been extensively documented in patients with hematological malignancies, but rarely described in patients with renal cell carcinoma (RCC). The objective of this study was to investigate the clinical characteristics and outcomes of TLS, a rare but life-threatening complication in RCC. Methods: Retrospective literature review and pooled analysis. Results: Ten cases of TLS were identified in patients with metastatic RCC (eight cases in published literature and two cases from our tumor registry). The median age of patients was 60 years (45-88). Seven cases (70%) of TLS were associated with a variety of treatment regimens, include sunitinib (42%), pazopanib (14.2%), nivolumab (14.2%), nivolumab and Ipilimumab (14.2%), and temsirolimus (14.2%). The median time to TLS from treatment 16 days (14-28). Three (33%) patients had spontaneous TLS. All patients had extensive metastatic disease at the time of presentation, with visceral metastases documented in 100% of TLS cases. The majority of cases were clear renal carcinoma (one case of sarcomatoid, and another with extensive rhabdoid feature). All cases were treated with aggressive supportive measures, and four patients received rasburicase. The mortality rate was 57% among seven cases of treatment related TLS. The mortality rate was 100% in the three patients with spontaneous TLS. Conclusions: TLS in RCC can occur both after treatment and spontaneously, and is associated with very high mortality. Our findings underscore the importance of heightened awareness, risk assessment, and early prevention of this previously underdiagnosed oncologic emergency.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Tumor lysis syndrome associated with renal cell carcinoma

2019

Int Med

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Clinical characteristics and outcomes in those with primary extrahepatic malignancy and malignant ascites

et al. 2022

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Background Malignancy-related ascites accounts for approximately 10% of causes of ascites. Our AIM was to characterize the ascites fluid and correlate clinical outcomes in those with extrahepatic malignancy and ascites. Methods 241 subjects with extrahepatic solid tumors and ascites were reviewed from 1/1/2000 to 12/31/2019, 119 without liver metastasis and 122 with liver metastasis. Results Ascites fluid consistent with peritoneal carcinomatosis (PC) was most common, 150/241 (62%), followed by fluid reflecting the presence of portal hypertension (PH), 69/241 (29%). 22/241 (9%) had low SAAG and low ascites fluid total protein, with evidence of PC on cytology and or imaging in 20/22. Lung cancer was the most common malignancy in subjects with ascites due to PC at 36/150 (24%), pancreatic cancer was the most common in subjects with ascites with features of PH at 16/69 (23%). Chemotherapy or immunotherapy alone was the most common management approach. Significantly higher 5-year, 3-year and 1-year mortality rate were noted in subjects with evidence of PC on cytology/imaging versus subjects with no evidence of PC, and in subjects with liver metastasis compared to subjects without liver metastasis. Subjects with pancreatic cancer and evidence of PC on cytology/imaging had higher 1 and 5-year mortality rates compared to subjects without PC. Conclusions Ascites in solid tumor malignancy is most commonly due to PC. We also observed ascites fluid with characteristics of PH in 29% of subjects. Higher mortality rates in subjects with peritoneal carcinomatosis and liver metastasis were noted. These findings may help inform prognosis and treatment strategies.

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Clinical Features, Treatment, and Outcome of Tumor Lysis Syndrome in Germ Cell Tumors

Wang¹

2019

JUNS

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Background: Tumor lysis syndrome (TLS) is an oncologic emergency that can occur spontaneously or triggered by cancer treatment. This life-threatening condition is most commonly seen in hematologic cancers but is sometimes described in solid tumors such as germ cell tumors (GCTs). The objective of this study is to investigate the clinical characteristics and outcomes of TLS in GCTs.Methods: Retrospective review and pooled analysis.Result: Seventeen cases of TLS related to GCTs were identified. These included nonseminomatous GCT (7), seminoma (5), choriocarcinoma (2), ovarian (2), and intracranial germinoma (1). Nine cases (53%) of TLS were treatment-related and eight cases (47%) occurred spontaneously. The median age of patients was 34 years (range: 13-58), excluding one newborn baby. The median time from treatment to TLS was 2.1 days. Seven patients (41%) had liver metastases, but all patients had bulky disease. All of the patients received supportive measures; 4 (24%) patients received rasburicase and 11 patients (64%) underwent hemodialysis. The mortality rate was 44.4% among the nine cases of treatment-related TLS, and 37.5% in the eight patients with spontaneous TLS (STLS). Conclusion:TLS can occur in GCTs that have a high tumor burden. Almost 50% of TLS in GCTs happened spontaneously. Considering the life-threatening nature of TLS in GCTs, health care professionals should be alert and monitor for TLS in order to prevent or treat this potentially fatal complication.

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Liver metastasis as an independent predictor for mortality in patients who developed tumor lysis syndrome: Analysis of 132 patients with solid tumors.

Cited by 6 publications

References 0 publications

Tumor lysis syndrome associated with renal cell carcinoma

Tumor lysis syndrome associated with renal cell carcinoma

Clinical characteristics and outcomes in those with primary extrahepatic malignancy and malignant ascites

Clinical Features, Treatment, and Outcome of Tumor Lysis Syndrome in Germ Cell Tumors

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