Kirchner J A
Ann Otol Rhinol Laryngol. 1975 Nov-Dec;84(6):793-803. doi: 10.1177/000348947508400611.
In our patient population, cancer of the hypopharynx arose 19 times as often in the pyriform sinus as in the postcricoid space (152:8). Most of the growths were far advanced when first seen (90% T3), and enlarged cervical nodes were present in 66% of the patients. Three year survival rates free of disease were as follows: primary surgical treatment (laryngectomy, radical neck dissection) (8/28) 29%; primary radiotherapy (2/55) 4%; and combined preoperative radiation (12/33) 36%. Serial section studies of 51 surgical specimens indicate that T1 and T2 lesions, especially those confined in the medial wall, are probably curable by radiotherapy. Larger lesions invade deeply into the larynx and resemble transglottic growth in their pattern of spread. Conservation surgery would have been inadequate for all but perhaps one growth in this series of 51 lesions, because of the high rate of invasion by cancer into and through the thyroid cartilage and cricoid ring (22/51). Although surface presentation of this group of pyriform sinus cancers rarely reflected the extent of invasion, each of the 22 growths that invaded portions of the thyroid or cricoid cartilages was characterized by clinical involvement of the apex and lateral wall of the pyriform sinus on laryngoscopy or barium swallow.
在我们的患者群体中，下咽癌发生于梨状窦的频率是环状软骨后区的19倍（152例比8例）。大多数肿物初诊时已属晚期（90%为T3期），66%的患者有颈部淋巴结肿大。无病生存三年率如下：原发手术治疗（喉切除术、根治性颈清扫术）（8/28）为29%；原发放射治疗（2/55）为4%；术前综合放疗（12/33）为36%。对51份手术标本进行连续切片研究表明，T1和T2期病变，尤其是局限于内侧壁的病变，有可能通过放射治疗治愈。较大的病变会深入侵犯喉部，其扩散方式类似于声门旁型肿物。在这51个病变中，除了可能有一个肿物外，保喉手术对所有病变都不适用，因为癌侵犯甲状腺软骨和环状软骨并穿过它们的发生率很高（22/51）。虽然这组梨状窦癌的表面表现很少能反映侵犯范围，但在喉镜检查或吞钡检查中，侵犯甲状腺或环状软骨部分的22个肿物中的每一个都有梨状窦尖部和侧壁的临床受累表现。
