Background: Tumor lysis syndrome (TLS) is a critical oncologic emergency, particularly affecting patients with rapidly proliferating renal tumors or a high tumor burden post-cytotoxic chemotherapy. Over recent decades, the evolving therapeutic approaches in oncology have widened the range of genitourinary (GU) malignancies linked to TLS. However, there remains a lack of adequate literature on the incidence of TLS in GU malignancies. This study addresses this gap using National Inpatient Sample (NIS) data. Its primary objectives are to assess the risk of TLS in GU malignancies, identify associated demographic factors, and compare the findings with hematological malignancies leading to better management and preventive strategies.
Methods: The analysis of the NIS 2016-2019 dataset involved employing univariate and multivariate logistic regression analysis to identify predictors of TLS (P < 0.05). StataCorp. 2021, Release 17, College Station, TX: StataCorp LLC, BE version with Stata's svy command, and appropriate weights were utilized for the analysis. The overall fit was assessed using Receiver Operating Curves, and sensitivity analysis was conducted using the e-value package.
Results: Between 2016 and 2019, there were 51,385 (48,917 - 53,853) hospitalizations with TLS incidence. For this study, we specifically focused on 16,249 cases of TLS in patients undergoing treatment for the ten most common malignancies in the US. Older age, male sex, and black race were associated with higher odds of developing TLS. In GU malignancies, the odds of developing TLS were 1.68 (95%CI 1.35-2.09), still much lower than Leukemias and Lymphomas having the highest odds of TLS, respectively.
Conclusions: GU malignancies exhibit statistically significantly higher odds of TLS. Reduced renal function in some cases may affect the odds of TLS. As a result, there is an urgent need to establish tailored management guidelines to prevent TLS in GU malignancies to improve patient outcomes, reduce associated morbidity and mortality, and develop more cost-effective treatment regimens.
