Tumor Lysis Syndrome in Colorectal Cancer-A Systematic Review of Literature.

introductionTumor lysis syndrome (TLS) is a well-recognized oncologic emergency typically associated with hematologic malignancies, resulting from rapid tumor cell breakdown and causing severe metabolic disturbances. However, TLS is rare in solid tumors like colorectal cancer (CRC), and its occurrence and management in this setting remain poorly understood. This review aims to highlight and better characterize TLS in CRC through a review of current cases.

methodsWe systematically searched PubMed, Embase, and Scopus for TLS in patients with colorectal cancer occurring either following chemotherapy or spontaneously. After exclusion of duplicates and articles that did not meet eligibility criteria, 32 studies were included, comprising 11 spontaneous and 22 therapy-related TLS cases. We extracted quantitative and qualitative data for descriptive analysis.

resultsWe identified 32 reports encompassing 33 patients (16 males, 15 females; median age 58 years) with TLS. Pre-treatment LDH, AST, and ALT were elevated in all evaluable patients. Most tumors were adenocarcinoma (92%), neuroendocrine (8%). Among 15 patients with available histologic grading, grade 2 was most frequent (53%). Nearly all patients (94%) had stage IV disease. Metastases were most common in the liver (93%), followed by lung (30%) and bone (10%). TLS features included AKI in all patients with available data. Hyperuricemia was present in all evaluable cases (n = 32), hyperphosphatemia in 82%, hyperkalemia in 74%, and hypocalcemia in 52%. TLS was spontaneous in 11 patients (33%) and therapy-related in 22 (67%). Mean onset after therapy was 3.8 ± 2.5 days, excluding one 30-day outlier on capecitabine. The most frequent regimen was 5-fluorouracil–based therapy (5-FU) (55%), often combined with bevacizumab (33%). TLS-related mortality was 59%, with in-hospital mortality accounting for 55% of deaths.

conclusionTLS in CRC is associated with high mortality rate and shows no sex preference. Patients with TLS in CRC frequently exhibit Stage IV disease, liver metastases, hyperuricemia, and AKI. The condition has most often been described in patients receiving 5-FU based chemotherapy regimens; however, this observation likely reflects the widespread use of 5-FU as the foundational systemic therapy for CRC adenocarcinoma rather than implying a direct causal relationship between 5-FU and TLS. This review emphasizes the importance of heightened awareness for TLS in CRC patients with significant tumor burden and metastatic disease. Prompt recognition and treatment are critical to improving outcomes. Further research is needed to identify predictive biomarkers and develop strategies to mitigate TLS risk in CRC.