Fig. 4

The outcome of clonal competition between HPV-positive and HPV-negative laryngeal cancers. In general, wild-type normal cells (green) are preferred over mutant cells (yellow). Nevertheless, alterations in the tumor immune microenvironment resulting from distinct etiologies (HPV-positive cell exhibiting “hot” immunity and HPV-negative cell exhibiting “cold” immunity) may grant a competitive edge to mutant cells, enabling them to surpass wild-type cells and establish dominance within the field. Consequently, mutant normal cells undergo further transformation into tumor cells (red) under the influence of the surrounding environment and subsequently remaining competitive