Tumor Lysis Syndrome in Lung Cancer Patients: A Review of the Literature.

BACKGROUND

Tumor lysis syndrome (TLS) in patients with lung cancer (LC) is poorly characterized, due to its predominance in hematologic malignancies, creating a gap in both recognition and management strategies.

METHODS

We reviewed the literature to identify features that distinguish patients with lung cancer (LC) at high risk for tumor lysis syndrome (TLS) and poor prognosis, and to evaluate treatment outcomes. The PubMed database was queried through February 2025 in accordance with PRISMA guidelines. Twenty-nine case reports, including clinical courses and biochemical data of LC patients who developed TLS, were analyzed and appraised.

RESULTS

Risk factors for tumor lysis syndrome (TLS) included elevated uric acid and lactate dehydrogenase (LDH) at baseline, along with dyspnea, oliguria, and lethargy. Factors associated with increased mortality included high baseline LDH, symptomatic TLS, the need for renal replacement therapy, liver metastasis, and widespread metastatic disease. Rasburicase was associated with improved survival in a limited subset. Mortality in patients with lung cancer (LC) and TLS rivaled that observed in hematologic malignancies.

CONCLUSION

For patients with high-risk lung cancer (LC), proactive initiation of urate-lowering therapy and hydration along with rasburicase and continued hydration for those who develop tumor lysis syndrome (TLS) may reduce mortality. Further multicenter studies may influence diagnostic criteria, risk assessment, and prophylactic guidelines for TLS to better account for high-risk LC and other solid tumor patients.