Additionally, we investigated the T cell effector capacity program’s association with tumor stage, as previous studies have shown changes in cell states can affect tumor progression across cancer types.[71–73] In HNSCC, higher numbers of CD8 T cells have been previously shown to be associated with better prognosis, but the state of the T cell was not considered.[74] We showed that T cells are most cytotoxic at stage I, and shift to a more dysfunctional phenotype at stage II as the tumors progress, possibly reflecting the ability of tumors to create immune suppressive microenvironments. This evidence concerns the gene CD8A and neoplasm.