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目的 总结T4期梨状窝鳞状细胞癌的治疗效果.方法 无远处转移的T4期梨状窝鳞状细胞癌初治患者60例,根据治疗方式分为4组:单纯放疗组(R组)15例,平均放疗剂量为67.9 Gy;单纯手术组(S组)7例,全部行非喉功能保留手术;术前放疗加手术组(R+S组)16例,平均术前放疗剂量为49.8 Gy,其中3例行喉功能保留手术;手术加术后放疗组(S+R组)22例,全部行非喉功能保留手术,平均术后放疗剂量为58.5 Gy.结果 本组患者3年生存率为38.7%,5年生存率为32.4%.R组、S组、R+S组和S+R组的5年生存率分别为8.7%、33.3%、29.2%和47.7%.综合治疗患者(R+S组和S+R组)与单一治疗患者(R组和S组)的5年生存率分别为41.7%和13.6%,差异有统计学意义(P=0.02).R+S组和S+R组的5年总体生存率分别为29.2%和47.7%,差异无统计学意义(P=0.228).R+S组和S+R组的并发症发生率分别为50.0%和31.8%,差异无统计学意义(P=0.258).结论 T4期梨状窝鳞状细胞癌仍以计划性综合治疗为标准治疗,可较多采用术后放疗.

Objective To evaluate the treatment results of T4 squamous cell carcinoma of the pyriform sinus. Methods Sixity patients with T4 cancer of the pyriform sinus were included in this retrospective analysis.Fifteen patients were treated with radiotherapy alone(Ra group) with 67.9 Gy.Seven patients were treated with surgery alone(S group) with no laryngeal function sparing surgery.Sixteen patients were treated with preoperative radiotherapy with 49.8 Gy followed by surgery including three cases with laryngeal function sparing surgery(R + S group).Twenty-two patients were treated with surgery followed by postoperative radiotherapy with 58.5 Gy(S + R group),and there was no laryngeal function sparing surgery in this group.The survival rate was calculated using Kaplan-Meier method. Results The overall 5-year survival rate for all patients was 32.4%,8.7% for R group,33.3% for S group,29.2% for R +S group,47.7% for S + R group,41.7% for combined therapy group(R + S group and S + R group) and 13.6% for single therapy group(S group and R group).There was a statistically significant difference between the two groups(P = 0.02) .The overall 5-year survival rates for R + S group and S + R group were 29.2% and 47.7%,respectively,with no significant difference(P =0.228).Surgery complications for R + S group was 50.0% and 31.8% for S + R group,with no significant difference(P = 0.258). Conclusions Combined therapy is the standard treatment modality for T4 squamous cell carcinoma of the pyriform sinus.Surgery with postoperative radiotherapy seems to be more advantageous.