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The limited activity of immunotherapy in this setting reflects layered immune resistance shaped by impaired antigen visibility, redundant inhibitory receptor networks, suppressive myeloid and regulatory circuits, and metabolic\u2010epigenetic constraints within ascites and multicellular spheroids. These compartment\u2010specific features distinguish peritoneal disease from anatomically confined tumors and help explain why systemic immune reinvigoration alone rarely produces durable benefit. Here, we synthesize current evidence on the mechanisms that govern immune escape in ovarian cancer peritoneal dissemination, with emphasis on antigen presentation defects, checkpoint\u2010driven T\u2010cell exhaustion, anti\u2010phagocytic signaling, soluble suppressive mediators, and metabolic remodeling of the ascites microenvironment. We further examine how DNA damage response states intersect with innate immune sensing and discuss the translational implications of homologous recombination deficiency for combination treatment design. Finally, we propose a biomarker\u2010guided framework that links antigen\u2010presentation competence, immune engagement, dominant suppressive axes, and ascites\u2010specific biology to rational therapeutic matching. This mechanism\u2010centered view supports more precise trial design and provides a roadmap for combination immunotherapy in advanced ovarian cancer.<\/jats:p>","DOI":"10.1002\/jcp.70197","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:37:23Z","timestamp":1780897043000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immune Evasion in Ovarian Cancer Peritoneal Metastasis: Mechanisms and Biomarker\u2010Guided Therapeutic Matching"],"prefix":"10.1002","volume":"241","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8115-8193","authenticated-orcid":false,"given":"Xiaodong","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Oncology, The Second Xiangya Hospital Central South University Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of 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