Unraveling neutrophil diversity in ovarian cancer: bridging clinical insights and basic research

Ovarian cancer has the poorest prognosis among all gynecological malignancies and frequently leads to peritoneal dissemination. Several studies have described the relationship between ovarian cancer and neutrophils. However, the significance and detailed functions of neutrophils remain unclear compared with those of other immune cells. In clinical studies, there are many reports on the prognostic impact of neutrophil indicators, such as the neutrophil-to-lymphocyte ratio (NLR), neutropenia, and the use of granulocyte colony-stimulating factor (G-CSF). Neutrophils display both tumor-suppressive and tumor-promoting functions in the tumor microenvironment, with the latter being more commonly reported. However, a unified view is yet to be achieved. The aim of this review is to describe the role of neutrophils in ovarian cancer and to discuss potential therapeutic interventions targeting neutrophils. We reviewed clinical and basic research on the relationship between neutrophils and ovarian cancer. In particular, we focused on the various functions of neutrophils in the tumor microenvironment in ascites and peritoneal dissemination. Finally, we describe the future perspectives that can be obtained by aggregating individual studies. In conclusion, effective therapeutic targeting of neutrophils in ovarian cancer peritoneal dissemination necessitates approaches that specifically account for their diverse phenotypic states.