<div>By Figdraw.</div><div>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.</div><div>3. Prevention and therapy</div><div>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)<sup>[61,62]</sup>. 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<sup>[63]</sup>.</div><div>3.1 Metformin</div><div>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<sup>[64]</sup>. 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<sup>[65,66]</sup>.
Currently, a nonrandomized phase II study combining metformin and
chemotherapy in advanced-stage ovarian cancer without diabetes has
reached promising conclusions.</div><div>3.2 Exercise and weight control</div><div>Some systematic reviews have concluded that exercise is always relevant
to better outcomes of ovarian cancer<sup>[67]</sup>.
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<sup>[68]</sup>. The classical action mechanism is
concentrated on secretion of adipokines, insulin resistance, and chronic
inflammation<sup>[69,70]</sup>. Yueying Liu et al. confirmed
that obesity and a high-fat diet influence immune cell infiltration. For
example, CD45<sup>+</sup> 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<sup>[71]</sup>. Recent data have suggested that
exercise might contribute to the activation of M1 macrophages, which
arouse antitumor immune responses<sup>[72]</sup>. Exercise
intervention during or following ovarian cancer therapy might improve
the lives of these patients.</div><div>4. Conclusions</div><div>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.</div><div>Data Availability Statement</div><div>Data openly available in a public repository.</div><div>References</div><div>[1] Torre L A, Trabert B, Desantis C E, et al. Ovarian cancer
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