<h3>Purpose/Objective(s)</h3> Tumor response to radiation is dependent on the presence of oxygen with hypoxic tumors requiring a two to three-fold higher dose of radiation to achieve clinical equipoise. Head and neck squamous cell cancers (HNSCC) are the most hypoxic among various cancers, as observed in the The Cancer Genome Atlas (TCGA) dataset of 10,700 samples. Potentially related to this, tumor microenvironment (TME) in specific subsites has more anaerobes compared to the normal oral mucosa. The purpose of our study was to analyze the relationship between tumor subsite, hypoxia, and the local tumor microbiome in HNSCC using data from TCGA. <h3>Materials/Methods</h3> Tumor RNAseq samples from TCGA were processed through the exoTIC (exogenous sequencing in tumors and immune cells) pipeline to identify and count exogenous sequences, filter contaminants, and normalize expression values. The software ‘tmesig' was used to calculate gene expression signatures of the TME, including the Buffa hypoxia (BH) score, a validated gene signature that uses 52 hypoxia-regulated genes. Microbe relative abundances were modeled as the response variable with primary tumor location and a high vs low tertile BH score as predictor variables using a gamma-distributed generalized linear regression via the "stats'' package in R. Adjusted p-value of <0.05 was considered significant. <h3>Results</h3> A total of 357 patients were included [Oral cavity (OC) = 226, Oropharynx (OPx) = 53 and Larynx/Hypopharynx (LHPx) = 78] out of which HPV was present in 12.8%, 71.7% and 10.3% patients respectively in OC, OPx and LHPx tumors. The mean (SD) BH scores were 2.38 (18.17), -3.38 (20.45) and -4.97 (16.74) in OC, OPx and LHPx tumors, respectively, with higher values indicating greater hypoxia. The hypoxia signature was significantly higher for OC tumors compared to OPx (p= 0.044) and LHPx (p = 0.002), but was not statistically different between OPx and LHPx tumors (p= 0.625). Patients with upper tertile of BH scores had 395 microbes significantly enriched in tumors vs 307 microbes in patients with lower tertile of BH. The hypoxia expression signature was significantly associated with 413, 206 and 130 microbes in the OC, OPx and LHPx, respectively. Different strains of microbes were significantly associated with hypoxia depending on the tumor location, specifically, <i>Pseudomonas sp</i> in OC, <i>Actinomyces sp</i> and <i>Sulfurimonas sp</i> in OPx, and <i>Filifactor sp</i> in LHPx. In OPx cancer, there were no microbes significantly associated with hypoxia conditional in the presence of HPV. <h3>Conclusion</h3> Oral cavity tumors were associated with the greatest degree of hypoxia among HNSCC subsites, suggesting a potential mechanism for radiation resistance. In this study, we were able to identify an association between specific anaerobic microbes and relative hypoxia in different tumor subsites. Further investigation is required to determine if this is a causal relationship and whether modification of the microbiome in the TME can lead to reduced hypoxia and improved radiosensitivity and outcomes.
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