Abstract
Head and neck squamous cell carcinoma (HNSCC) continues to pose a major global health challenge, with over 600,000 new cases diagnosed annually and persistently poor survival outcomes despite advances in surgery, radiotherapy, and immunotherapy. Growing evidence implicates metabolic reprogramming, including enhanced glycolysis, glutaminolysis, lipid synthesis, and one-carbon/redox flux as a central driver of HNC initiation, progression, and therapy resistance. In contrast, metabolic crosstalk within the hypoxic, acidic tumor microenvironment (TME) further shapes immune evasion and stromal support. Recent innovations in mass spectrometry platforms (LC-MS, GC-MS, NMR) have attracted attention in clinical therapeutics, and spatial metabolomics imaging techniques now enable high-resolution in situ mapping of metabolites, revealing intratumoral heterogeneity and offering new insights into tumor-immune-stromal interactions and potential biomarkers for precision oncology. In this review, we integrate critical methodological considerations from sample collection and data-analysis workflows to analytical pitfalls with a balanced, pathway-focused analysis of HNSCC dysmetabolism, examine tumor immune stromal metabolic interactions, and highlight translational opportunities through emerging biomarkers, targeted inhibitors, and cutting-edge approaches such as single-cell and AI-driven metabolomics to chart a roadmap toward precision oncology for HNSCC.