Tumor lysis syndrome in solid tumors: A retrospective cohort study of the National Inpatient Sample from 2016 to 2019.

Akshit Chitkara University of California Riverside, Riverside, CA info_outline Akshit Chitkara, Akshita Khosla, Fnu Anamika, Kavin Raj, Jean-marie Koka, Bhuvaneswari Ramaswamy

Authors Akshit Chitkara University of California Riverside, Riverside, CA info_outline Akshit Chitkara, Akshita Khosla, Fnu Anamika, Kavin Raj, Jean-marie Koka, Bhuvaneswari Ramaswamy Organizations University of California Riverside, Riverside, CA, Crozer-Chester Medical Center, Chester, PA, Hackensack Meridian Ocean University Medical Center, Brick, NJ, Crozer-Chester Medical Center, Upland, PA, Ohio State University Wexner Medical Center, Columbus, OH Abstract Disclosures Research Funding No funding received None. Background: Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency. Patients with a rapidly proliferating tumor or high tumor burden after cytotoxic chemotherapy, predominantly in hematologic malignancies, are at increased risk of TLS. The advancement in therapeutic strategies of oncology in the past few decades has expanded the spectrum of malignancies associated with TLS. A dearth of literature on the incidence of TLS in various solid malignancies exists. Using the National Inpatient Sample (NIS) data, this study aims to highlight the solid malignancies at risk of TLS, highlight the demographic factors, and draw a comparison with that in hematological malignancies. Methods: The NIS 2016-2019 dataset was analyzed utilizing univariate and multivariate logistic regression analysis for the 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 used to perform the analysis. The overall fit was analyzed using Receiver Operative Curves (ROC), and sensitivity analysis was analyzed using the e-value package. Results: From 2016-2019, a total of 51,385 (48,917-53,853) hospitalizations had an incidence of TLS. We included 16,249 cases of TLS in patients treated for the ten most common malignancies in the US. We found that older age, male sex, and black race were associated with higher odds of TLS. It was reported highest in large hospitals and urban non-teaching hospitals. The regional distribution of the TLS suggests the highest odds in the Western region. The odds of getting TLS were highest among Leukemias and Lymphomas, respectively. Among solid tumors, the odds of getting TLS were highest in uterine cancer patients, followed by lung, breast, pancreatic, and liver cancer among the top five. (Table). Conclusions: In this study, we conclude that solid tumors, mainly uterine, followed by lung and breast, have significantly higher odds of TLS, more so in larger or non-teaching hospitals. There is a need to establish specific management guidelines to prevent these TLS cases that will improve the morbidity and mortality associated with TLS and help build more cost-effective treatment regimens. Demographic Characteristics OR of TLS 95% CI Hematologic Malignancies OR of TLS 95% CI Age 1.01 1.006 to 1.009 Leukemias 56 52.59 to 59.84 Female vs. Male Sex 0.61 0.58 to 0.64 Lymphomas 34.16 31.62 to 36.90 Black Race vs. White 1.31 1.22 to 1.41 Solid Malignancies OR of TLS 95% CI Asian or pacific Islanders vs. White 1.31 1.15 to 1.48 Uterine cancer 6.82 5.22 to 8.91 Large vs. Small sized hospitals 2.05 1.82 to 2.31 Lung cancer 4.74 4.27 to 5.26 Medium vs. Small sized hospitals 1.39 1.23 to 1.57 Breast cancer 3.39 2.77 to 4.16 Urban non-teaching vs. Rural hospitals 1.66 1.38 to 1.99 Pancreatic cancer 3.21 2.56 to 4.02 Western vs. Northeast region 1.18 1.05 to 1.33 Liver cancer 3.19 2.50 to 4.08