Spatiotemporal immune heterogeneity and precision immunotherapy for ovarian cancer.

BACKGROUND: The clinical benefit of immunotherapy in ovarian cancer (OC) remains limited. The primary reason is not simply a lack of immune activation, but rather the marked spatiotemporal heterogeneity of the tumour immune microenvironment. Previous reviews have mainly focused on individual immune components, immunosuppressive mechanisms, or therapeutic approaches, with less systematic integration of distinct anatomical niches, treatment-stage evolution, and their implications for precision immunotherapy selection. MAIN BODY: In this review, we propose a spatiotemporal immune heterogeneity framework to understand differential immunotherapy responses in OC. We first summarize the distinct immune landscapes across different anatomical niches, highlighting how anatomical niches shape immune suppression, immune exclusion and therapeutic vulnerability. We further discuss temporal remodelling of the tumour immune microenvironment during disease progression, emphasizing that immune states represent dynamic biological processes rather than fixed tumour characteristics. Based on this concept, we review biomarker-guided stratification strategies. Precision therapeutic strategies are further discussed according to distinct immune ecosystems. Finally, we highlight major challenges in clinical translation, including biomarker standardization, multicentre validation and the development of artificial intelligence-assisted decision systems. CONCLUSION: By linking immune ecosystem evolution, this review provides a framework for transitioning OC immunotherapy towards dynamic and precision-guided clinical management.