Understanding the immune microenvironment of ovarian cancer

Ovarian cancer remains the most lethal gynecological malignancy, yet immune checkpoint inhibitors (ICIs) demonstrate limited clinical efficacy due to profound CD8^+- T cell exhaustion within a highly heterogeneous tumor immune microenvironment (TME). Single-cell RNA sequencing (scRNA-seq) has revolutionized our understanding of this complex ecosystem by resolving rare immune subsets, reconstructing lineage trajectories, and mapping dynamic intercellular signaling networks. Emerging single-cell atlases reveal that terminally exhausted T cells evolve from plastic progenitor populations, notably GZMK^+- subsets, while ascitic fluid functions as a distinct immunomodulatory reservoir that continuously shapes intratumoral immune dynamics. Furthermore, multi-compartment transcriptomic profiling uncovers myeloid-lymphoid crosstalk that actively sustains localized immunosuppression and drives therapeutic resistance. These high-resolution molecular insights are increasingly leveraged to accurately predict ICI responsiveness, rationally design novel combinatorial regimens, and strategically guide next-generation adoptive cellular therapies. This review summarizes the scRNA-seq-driven advances in characterizing the ovarian cancer TME, emphasizing how single-cell resolution dismantles immunosuppressive barriers to T cell reinvigoration and establishes a robust translational framework for precision immunotherapy.