“…While infection with human papillomavirus accounts for an increasing number of patients with oropharyngeal cancers, risk factors, especially viruses, in OSCC nonsmokers and non-drinkers, are unclear 11,12 . Head and neck cancer (HNC), including OSCC, is a heterogeneous disease that develops through a complex, multi-step process involving genetic alterations, growth regulation, apoptosis, angiogenesis, invasion and metastasis; moreover, it is influenced by the individual's genetic predisposition and environmental exposure to carcinogens 13,14 . This heterogeneity is confirmed in daily practice by the observation that patients with clinically similar tumours have different treatment responses and outcomes 15,16 .…”