| Objective: To understand the clinical characteristics of hospitalized patients of malignant tumor who were accompanied with hyperuricemia and provide clinical evidence for their uric acid management.At the same time,the clinical efficacy and safety of febuxostat in hospitalized patients with malignant tumor and hyperuricemia were observed.Methods: The clinical data of malignant tumor patients with hyperuricemia hospitalized in the Affiliated Hospital of Qingdao University from January 1,2016 to December 31,2020 were collected by retrospective analysis,and their age distribution,gender differences,tumor types,main complications and use of uric acid-lowering drugs were analyzed.Further,through inclusion and exclusion criteria,a total of 138 eligible inpatients with chemotherapy were Screened out,and they were divided into febuxostat group and allopurinol group according to their medication.The clinical data of the selected patients were collected,including age,sex,height,weight,body mass index(BMI),tumor type,lactate dehydrogenase,white blood cell count,serum Uric Acid(SUA),serum Creatinine(Scr),adverse reactions and Tumor lysis syndrome(TLS).To analyze the curative effect of febuxostat in patients with malignant tumor complicated with hyperuricemia,and compare it with the curative effect and safety of allopurinol.Results:1.Age composition: Among 10,443 patients with malignant tumor complicated with hyperuricemia,the median age of the patients is 61(51,67)years old,of which 201(1.92%)are under 18 years old,908(8.96%)are between 18 and 40 years old,and 5,818(55.77%)are between 41 and 65 years old.2.Composition of sex ratio: Among 10,443 patients with malignant tumor complicated with hyperuricemia,there were 7,957 males(76.19%)and 2,486 females(23.81%),and the male-female ratio was about 3.2:1.3.Tumor types: Among the tumor patients with hyperuricemia,the top twelve tumor types with the highest proportion are lung cancer(24.94%),liver cancer(1585%),gastric cancer(893%),malignant lymphoma(852%)and leukemia(771%)There were 521 cases of colon cancer(4.99%),433 cases of multiple myeloma(4.24%),349 cases of esophageal cancer(3.34%),336 cases of bladder cancer(3.22%)and 316 cases of breast cancer(3.03%).There were 2084 patients(19.96%)with secondary malignant tumors(including bone,lymph nodes,lung,liver,brain,etc.).4.Complications: The top four diseases with the most types of complications are hypertension 3020(28.92%),coronary heart disease 1042(9.98%),type 2 diabetes 974(9.33%)and chronic hepatitis B 620(5.94%).5.Usage of uric acid-lowering drugs: There were 2,289 patients(21.92%)whose blood uric acid level was higher than 540μmol/L,of which 186(8.13%)used febuxostat,123(5.38%)used allopurinol and 105(4.59%)used benzbromarone.There were 2598 patients(24.88%)whose blood uric acid level was 480～539μmol/L,including 115 patients(4.43%)who used febuxostat,90 patients(3.46%)who used allopurinol,103 patients(3.96%)who used benzbromarone and sodium bicarbonate tablets.6.Efficacy of febuxostat in the treatment of malignant tumor complicated with hyperuricemia: According to the inclusion and exclusion criteria,62 patients were included in the febuxostat group.After one week of treatment,SUA and Scr levels were significantly lower than those before treatment,and the difference was statistically significant(P < 0.05).e GFR levels were significantly higher than those before treatment,and the difference was statistically significant(P < 0.05).Compared with before treatment,SUA and Scr in three different TLS risk stratification groups decreased significantly(P < 0.05),but there was no significant difference among the three groups(P > 0.05).7.Comparison of curative effect and safety between febuxostat and allopurinol: 40 patients in each group were enrolled after the matching of propensity score.The SUA and Scr levels of the two groups were lower than those before treatment,with statistical significance(P < 0.05).Among them,SUA in the febuxostat group decreased more than that in the allopurinol group,while Scr in the allopurinol group decreased more than that in the febuxostat group,and there was no significant difference between the two groups(P > 0.05).During the treatment,there was no gout attack in the two groups.There were 2gastrointestinal adverse reactions and 1 transaminase increase in the febuxostat group,2 skin rashes in the allopurinol group,3 gastrointestinal adverse reactions and 1 transaminase increase in the allopurinol group.The incidence of adverse reactions was 7.5% in the febuxostat group and 15% in the allopurinol group,with no significant difference(P > 0.05).One case in allopurinol group and one case in febuxostat group met the diagnostic criteria of tumor lysis syndrome in laboratory,and no clinical tumor lysis syndrome occurred in both groups.Conclusions:1.Hospitalized patients with malignant tumor and hyperuricemia are mostly from 41 to 65 years old,and there are more males than females.2.The utilization rate of uric acid-lowering drugs in hospitalized patients with malignant tumor and hyperuricemia is low.3.Febuxostat can effectively reduce the uric acid level of malignant tumor patients with hyperuricemia,and prevent the occurrence of TLS,and it has the same curative effect in patients with different risk stratification of TLS.4.The efficacy and safety of febuxostat in the treatment of malignant tumor patients with hyperuricemia are similar to those of allopurinol. |
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