By Figdraw.
Figure 1. In the microenvironment of adipose tissue infiltration, various cell components support adipose tissue and play important roles in ovarian cancer development via their specific functions and unique characteristics. Adipocytes, as the dominant cells in this environment, can secrete many kinds of cytokines and factors to enhance ovarian cancer cell growth, invasion, migration, angiogenesis and chemoresistance. Macrophages and mesenchymal stem cells depend on their own plasticity to make the local environment more suitable for ovarian cancer cells.
3. Prevention and therapy
Because of the lack of early detection and acquisition of drug resistance, complete victory over ovarian cancer is still extremely difficult. The current mainstream treatment includes primary debulking surgery (PDS) combined or not combined with chemotherapy or interval debulking surgery (IDS) combined with neoadjuvant chemotherapy. When patients finish primary therapy and achieve a complete clinical response or partial response, maintenance therapy is administered to improve their progression-free survival (PFS) and overall survival (OS)[61,62]. To unearth more latent mechanisms is significant. It is evident that omentum can provide a suitable environment for ovarian cancer cells. From the perspective of the roles of adipose cells and adipocytes, metformin might be promising for ovarian cancer therapy. More epidemiologic evidence supports that exercise could reduce ovarian cancer risk[63].
3.1 Metformin
Metformin is a classical hypoglycemic drug that could also be effective in several cancers, including ovarian cancer. It can inhibit the conversion of preadipocytes to adipocytes and block the biological process of adipocytes to interfere with ovarian cancer cell growth and invasion mediated by adipocytes[64]. Relevant clinical trials have proven that metformin is associated with better prognosis in ovarian cancer patients. It can downregulate the activity of IL-6/STAT3 and influence the expression of VEGF and TGF-β1. It can enhance sensitivity to cisplatin in ovarian cancer by altering the methylation of cancer-stem cells[65,66]. Currently, a nonrandomized phase II study combining metformin and chemotherapy in advanced-stage ovarian cancer without diabetes has reached promising conclusions.
3.2 Exercise and weight control
Some systematic reviews have concluded that exercise is always relevant to better outcomes of ovarian cancer[67]. Appropriate exercise is helpful for weight control, and increasing evidence supports that obesity, particularly the stock of visceral white adipose tissue (WAT), increases the occurrence and mortality of ovarian cancer[68]. The classical action mechanism is concentrated on secretion of adipokines, insulin resistance, and chronic inflammation[69,70]. Yueying Liu et al. confirmed that obesity and a high-fat diet influence immune cell infiltration. For example, CD45+ lymphocyte (B-cell marker), whole macrophage, and M1-polarized macrophage infiltration decreased in the obesity group while M2-polarized macrophages showed no significant change. The alteration of the immune microenvironment might open up another mechanism linking obesity and ovarian cancer[71]. Recent data have suggested that exercise might contribute to the activation of M1 macrophages, which arouse antitumor immune responses[72]. Exercise intervention during or following ovarian cancer therapy might improve the lives of these patients.
4. Conclusions
The omentum acts as the most frequent location where ovarian cancer cells spread for subsequent metastasis. It covers the surface of abdominal organs, and its enormous endocrine function and particular structural composition can provide a suitable and specific environment for ovarian cancer cell growth, invasion, migration and chemoresistance. Various cell compositions take part in ovarian cancer genesis and development via energy metabolism regulation, immune reactions and many other processes. All of the above molecules are just the tip of the iceberg. Investigations performed to reveal additional functions of the omentum, especially adipose tissue, might offer more effective and satisfactory therapeutic solutions for patients suffering from ovarian cancer.
Data Availability Statement
Data openly available in a public repository.
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