CD31 and VEGF are prognostic biomarkers in early-stage, but not in late-stage, laryngeal squamous cell carcinoma

Abstract Background Patients suffering from squamous cell carcinoma of the larynx (LSCC) with lymphatic metastasis have a relatively poor prognosis and often require radical therapeutic management. The mechanisms which drive metastasis to the lymph nodes are largely unknown but may be promoted by a pro-angiogenic tumor microenvironment. In this study, we examined whether the number of microvessels and the expression level of vascular endothelial growth factor (VEGF) in the primary tumor are correlated with the degree of lymph node metastasis (N-stage), tumor staging (T) and survival time in LSCC patients. Methods Tissue-Microarrays of 97 LSCC patients were analyzed using immunohistochemistry. The expression of VEGF was scored as intensity of staining (low vs high) and the number of CD31-positive vessels (median </≥7 vessels per visual field) was counted manually. Scores were correlated with N-stage, T-stage and 5-year overall survival rate. Results A high expression of angiogenic biomarkers was not associated with poor overall survival in the overall cohort of patients. Instead high CD31 count was associated with early stage cancer (p = 0.004) and in this subgroup high VEGF expression correlated with poor survival (p = 0.032). Additionally, in early stage cancer a high vessel count was associated with an increased recurrence rate (p = 0.004). Conclusion Only in the early stage subgroup a high expression of angiogenic biomarkers was associated with reduced survival and an increased rate of recurrence. Thus, biomarkers of angiogenesis may be useful to identify high risk patients specifically in early stage LSCC

Unacknowledged and unwanted? Environmental refugees in search of legal status

Environmental displacement is a global phenomenon affecting millions of people. Due to climate change and the corresponding sea-level rise, it is estimated that about eight million of indigenous people of Pacific Islands will be forced to settle elsewhere by 2050. This is one of many examples confirming the need to ascertain the legal status of environmental refugee in international law. The term environmental refugee is controversially discussed and internationally not recognised. First, this article discusses the reasons for reluctance of international organisations to accept this term. Second, noting the cold reception of this term at the regional and state levels, a discussion on whether fears associated with this term are based on solid arguments becomes pertinent. Third, this article outlines the possibility of granting refugee status under international law, especially under human rights and environmental law. Fourth, academic discourses will be examined as they play a crucial role in the conceptual development of environmental refugee and, to some academics, the existing refugee definition already encompasses environmental refugees. Taking into account the developments of the environmental and human rights regime, this article concludes that time is ripe for international law to provide refugee status to environmentally displaced people. © 2012 Copyright Taylor and Francis Group, LLC