In the hypoxic TME of ESCC, the receptor tyrosine kinase insulin-like growth factor 1 (IGF-1R) is upregulated and increases the transcription of argininosuccinate synthetase 1 (ASS1) regulated by c-MYC, achieving reprogramming of arginine metabolism (14). This evidence concerns the gene ASS1 and esophageal squamous cell carcinoma.