Background: Patients with solid tumors are usually classified as being at low to intermediate risk for developing tumor lysis syndrome (TLS); however, there have been a growing number of case reports describe TLS in patients with solid tumors. Data regarding clinical features, treatment, and survival outcomes in solid tumors are limited. It is unclear whether liver metastasis represents an individual risk factor for TLS. Methods: A pooled analysis of published cases of TLS in solid tumor patients was performed. Descriptive statistics, such as frequency, medians, and ranges, were used to characterize the pooled sample. The survival rate was calculated using log-rank and Kaplan-Meyer analyses. Results: The median age of 132 solid tumor patients who developed TLS was 57 (8-94). Male: female = 1.69. The most common sites were gastrointestinal (29%); genitourinary (17%); lung cancer (16%); melanoma (11%), breast cancer (8.3%). Among the typical biochemical findings of TLS, acute renal insufficiency and hyperuricemia were identified in nearly all patients and increased serum LDH were reported in over 71% of patients. 72% of patients had liver metastatic disease. 23% patients had spontaneous TLS. The rest (77%) of TLS was associated with a variety of treatment regimens, including chemotherapy, immunotherapy, hormonal, radiation therapy, transarterial chemoembolization (TACE) and surgery. The median time from treatment to TLS was 3 days (0.3-21). Seventy-two of 132 (59%) patients died during the acute episode of TLS: 65% patients with liver metastasis and 26% patients without liver metastasis. In a multivariate analysis, older age (HR 2.64; 95% Confidence Interval 1.48-4.70; p = 0.001) and liver metastasis (HR 3.48; 95% CI 1.45-4.71; P = 0.005) were identified as independent predictors for increased mortality. Conclusions: TLS in elderly patients with solid tumors with liver metastases is associated with extremely poor clinical outcome, likely due to late onset after anticancer therapy, under-diagnosis of TLS and missed opportunity for intervention. While TLS in solid tumors is rare, close monitoring and prophylaxis should be considered in these patients.