Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Eur J Oncol Nurs. 2022 Jun;58:102119. doi: 10.1016/j.ejon.2022.102119. Epub 2022 Mar 10.
Although subcutaneous steroid injections are conventionally used to treat extravasation of vesicant anticancer drugs, their effects on the extravasation site remain unclear. We investigated the association between subcutaneous steroid injection in patients with extravasation of vesicant anticancer drugs and incidence of skin ulcers requiring surgery.
We performed a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We identified patients with extravasation of vesicant anticancer drugs who were prescribed steroid ointment or cream on the same day as vesicant drug use between July 2010 and March 2019. The exposure group consisted of patients who had received subcutaneous steroid injections and local anesthetic in addition to topical steroids, whereas the control group had received topical steroids alone. The outcome was the incidence of skin surgical procedures during hospitalization. We performed a mixed-effect logistic regression analysis with random intercept for each hospital to compare outcomes between the groups.
We identified 7284 patients from 704 hospitals, including 3713 patients who had received topical steroids alone and 3571 who had received subcutaneous steroid injection in addition to topical steroids. According to mixed-effect logistic regression analysis, subcutaneous steroid injection was significantly associated with a higher incidence of skin surgery (odds ratio, 1.61; 95% confidence interval, 1.14-2.26; P = 0.007). Barthel Index, type of cancer, and type of vesicant drugs were also associated with surgery.
Subcutaneous steroid injections after extravasation of vesicant anticancer drugs are associated with more frequent skin surgery. Randomized controlled trials are required to evaluate the safety and effectiveness of steroid injection.
尽管皮下类固醇注射常用于治疗刺激性抗癌药物外渗，但它们对外渗部位的影响仍不清楚。我们研究了接受刺激性抗癌药物外渗的患者接受皮下类固醇注射与需要手术治疗的皮肤溃疡发生率之间的关系。
我们使用日本诊断程序组合住院患者数据库进行了回顾性队列研究。我们确定了在 2010 年 7 月至 2019 年 3 月期间使用刺激性药物的同一天，同时开具类固醇软膏或乳膏的刺激性抗癌药物外渗患者。暴露组患者接受了局部皮质类固醇以外的皮下类固醇注射和局部麻醉，而对照组仅接受了局部皮质类固醇治疗。结局是住院期间皮肤手术的发生率。我们使用混合效应逻辑回归分析，对每个医院进行随机截距，比较两组的结果。
我们从 704 家医院中确定了 7284 名患者，其中 3713 名患者仅接受了局部皮质类固醇治疗，3571 名患者在接受局部皮质类固醇治疗的同时接受了皮下类固醇注射。根据混合效应逻辑回归分析，皮下类固醇注射与皮肤手术发生率升高显著相关（比值比，1.61；95%置信区间，1.14-2.26；P=0.007）。巴塞尔指数、癌症类型和刺激性药物类型也与手术相关。
接受刺激性抗癌药物外渗后进行皮下类固醇注射与更频繁的皮肤手术相关。需要进行随机对照试验来评估类固醇注射的安全性和有效性。
