Long-term ovarian cancer survivors: spatial transcriptomics depict ligand-receptor crosstalk heterogeneity at the tumor-stroma interface

Advanced high-grade serous ovarian cancer (HGSC) is an aggressive disease that accounts for 70% of all ovarian cancer deaths. Nevertheless, 15% of patients diagnosed with advanced HGSC survive more than 10 years. The identification of predictive markers associated with tumors developed from these long-term survivors (LTS) is crucial to identifying therapeutic targets for the disease, and thus improving patient survival rates. Reports to date have not fully established the stromal heterogeneity of the tumor microenvironment (TME) in ovarian cancer and its association with clinical outcomes. We used a spatial transcriptomics platform to generate spatially resolved transcript profiles in treatment naive advanced HGSC from LTS and short-term survivors (STS), and determined whether cancer-associated fibroblasts (CAFs) heterogeneity is associated with survival in patients with advanced HGSC. We integrated spatial transcriptomics with single-cell RNA sequencing data to distinguish tumor and stroma regions, and developed a method to investigate spatially resolved ligand-receptor interactions between various tumor and CAF subtypes in the TME. In addition, we used multiplex immunohistochemistry techniques to validate our findings. We found that a specific subtype of CAFs and its spatial location relative to a particular ovarian cancer cell subtype in the TME correlate with long-term survival in advanced HGSC patients. We also demonstrated that significant APOE- LRP5 crosstalk occurred at the stroma-tumor interface in tumor tissues from STS compared to LTS, suggesting that such crosstalk plays a crucial role in modulating the malignant phenotype of HGSC, and could serve as a predictive biomarker of patient survival. ### Competing Interest Statement The authors have declared no competing interest.