Tumor Lysis Syndrome Associated with Urothelial Cancer: A Case Series

Background: Tumor lysis syndrome (TLS) is an oncologic emergency with limited treatment options. Although the vast majority of TLS is associated with rapidly proliferating hematologic malignancies, it is often overlooked in solid tumor cases and has only been rarely associated with urothelial carcinomas. The objective of this review is to investigate the clinical characteristics and outcomes of TLS in patients with urothelial carcinoma.

Methods: Retrospective literature and case review and pooled analysis.

Results: Four cases of TLS in urothelial carcinoma were identified in over 180 published cases of TLS in solid tumors; one additional case was included from our patient database. The median age of these patients was 72 years (range: 63-77) and 60% were female. Two patients had urothelial carcinoma of the renal pelvis and three had bladder cancer with metastases. All of these cases were associated with therapy-induced TLS with a median time to event of 14 days (range: 8-22 days) after receiving chemotherapy. Laboratory parameters were consistent among all cases with elevations in uric acid and LDH, hypocalcemia, hyperphosphatemia, and hyperkalemia. Treatment for TLS included aggressive supportive measures with intravenous hydration. One patient received hemodialysis; four of the five patients received urate oxidase, while one patient received allopurinol as treatment support. The mortality in this case series was 60%.

Conclusion: TLS in urothelial cancer is associated with very high mortality. TLS should be considered as a differential diagnosis when evaluating acute kidney injury and electrolyte abnormalities in patients with urothelial cancer especially in cases of high tumor volume and rapid growth.

Keywords: Urothelial carcinoma; Transitional cell carcinoma; Tumor lysis syndrome; Oncologic emergency