1. Origin and Prodromal Lesions:

It mainly originates from the fallopian tube epithelium, and the key precursor lesions are fallopian tube serous intraepithelial carcinoma (STIC), etc., STIC is more common in BRCA1/2 mutated people, and peritoneal metastases are characterized by multifocality.

2. Key molecular characteristics:

TP53 gene mutations almost completely covered (disease markers), and 15%-25% had genetic predisposition (mainly BRCA1/2 mutations). The tumor microenvironment was immunosuppressive, and CD8+ T cell infiltration suggested a better prognosis.

3. Risks and protection factors:

Risk factors include nulliparity, obesity, postmenopausal hormone replacement therapy, etc.; oral contraceptives, fertility and lactation, tubal ligation, etc. are protective factors, and bilateral salpingo-oophorectomy after BRCA mutation can reduce the risk of morbidity.

1. Clinical symptoms and diagnostic methods

▣ Early symptoms are vague, such as bloating, pelvic pain, early satiety, frequent urination, etc., which are easily confused with gastrointestinal diseases; In the advanced stage, weight loss, fatigue, and changes in bowel habits may occur.

▣Diagnostic methods: pelvic ultrasound, abdominal/pelvic CT/MRI, PET (in some cases), serum tumor markers (CA125, HE4, OVA1) auxiliary evaluation, and the final diagnosis is dependent on pathological biopsy.

2. Installment standards

▣ Using FIGO staging and TNM staging system, it is divided into stages I.-IV., and the core is based on the extent of tumor invasion (ovarian/fallopian tube local, pelvic spread, abdominal metastasis, distant metastasis).

▣ Surgical staging should pay attention to pelvic and para-abdominal lymph node evaluation, and 15%-20% of patients with limited stage may be upgraded to stage III due to lymph node metastasis.

1. Surgical treatment: pursue complete tumor reduction

▣ Early stage patients: comprehensive staging surgery, including total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymph node sampling and peritoneal biopsy.

▣ Advanced patients: priority is given to evaluating the feasibility of surgery, and patients who are eligible for surgery after evaluation by doctors will undergo primary tumor cytoreductive surgery, with the goal of no gross residual lesion (R0 resection); If this is not feasible, neoadjuvant chemotherapy should be given first, followed by intermittent tumor reduction.

▣ Relapsed patients: For those who are platinum-sensitive and eligible, secondary debulking combined with chemotherapy can improve survival; Patients with oligometastasis or long treatment-free intervals may be considered for triple debulking.

2. Chemotherapy regimen: stratified selection

▣ First-line chemotherapy: platinum-based combination regimen (carboplatin + paclitaxel as the standard), some patients can be combined with intraperitoneal chemotherapy (GOG-172 regimen) or bevacizumab (VEGFi).

▣ Relapsed chemotherapy: platinum-sensitive relapse (recurrence interval ≥ 6 months) with platinum-based combination regimen; For relapse of platinum resistance (< 6 months), a nonplatinum regimen (eg, liposomal doxorubicin, topotecan) in combination with bevacizumab or an antibody drug conjugate (ADC) is used.

3. Targeted and immunotherapy: precise breakthroughs

▣PARP inhibitors (PARPi): the core of first-line maintenance therapy for patients with BRCA mutations or HRD positivity, significantly prolonging progression-free survival (PFS), commonly used drugs include olaparib, niraparib, and fluzoparib.

▣ Anti-angiogenic therapy: Bevacizumab can be used in combination with chemotherapy for advanced or relapsed patients, and can also be used as a maintenance therapy option.

▣ Emerging therapies: patients with folate receptor α positive can use the antibody drug conjugate (ADC) mivirtuximab and soratancin, and HER2-positive patients can try trastuzumab and drunotecan; Immunotherapy (PD-1/PD-L1 inhibitors) has limited efficacy as a single agent, and combination treatment models are still being explored.

4. Maintenance therapy: stratified decision-making

▣ BRCA mutation/HRD positive: PARPi monotherapy or PARPi+ bevacizumab combination maintenance.

▣ HRD negative: niraparib monotherapy or bevacizumab monotherapy maintenance (if bevacizumab was used during chemotherapy).

1. Recurrence monitoring and treatment

▣Monitoring indicators: serum tumor markers (CA125), imaging examination, circulating tumor DNA (ctDNA) can indicate minimal residual disease, but do not guide treatment initiation for the time being.

▣ Treatment principle: Chemotherapy, targeted therapy or palliative care can be selected according to platinum-sensitive status, tumor burden, and patient physical status, and platinum-based chemotherapy can still be used again after PARPi exposure.

2. Supportive treatment and quality of life assurance

▣ Core content: pain management, nutritional support, psychological intervention (relieving anxiety and depression, fear of relapse), early intervention and palliative care to improve symptoms.

▣Long-term follow-up: monitor long-term side effects of treatment (neuropathy, cognitive impairment, cardiovascular disease, osteoporosis), screen for second primary tumors, and provide genetic counseling.

▣Optimize personalized treatment: Accurately select options based on molecular typing (HR status, tumor mutational burden, etc.) to explore the combination strategy of PARPi with other drugs.

▣Overcoming treatment resistance: Developing new DNA repair pathway inhibitors such as ATR and WEE1 to improve platinum resistance and PARPi resistance.

▣Immunotherapy breakthrough: clinical exploration of tumor vaccines, CAR-T cell therapy, and immune checkpoint inhibitor combination regimens.

▣ Emphasize diversity in clinical research: include more patients from ethnic minorities and different socioeconomic backgrounds to reduce health inequalities.