卵巢癌是最致命的妇科恶性肿瘤。铂类化疗是卵巢癌治疗的基础，尽管大多数患者最初患有铂敏感性疾病，但经过多次复发后，他们将获得耐药性。铂耐药性复发性卵巢癌预后不良，治疗选择有限，疗效有限。对铂类化合物的耐药是一个复杂的过程，涉及不仅肿瘤细胞而且肿瘤微环境的多种机制。本综述讨论了卵巢癌细胞对铂类化疗的耐药机制，重点关注药物进出通路的变化、DNA修复、表观遗传调控的失调以及肿瘤微环境在获得铂耐药表现中的作用。此外，我们还回顾了有望改善这些患者不良预后的可行替代治疗方法，讨论当前策略、新颖组合和治疗药物。

Ovarian cancer is the most lethal gynecologic malignancy. Platinum-based chemotherapy is the backbone of treatment for ovarian cancer, and although the majority of patients initially have a platinum-sensitive disease, through multiple recurrences, they will acquire resistance. Platinum-resistant recurrent ovarian cancer has a poor prognosis and few treatment options with limited efficacy. Resistance to platinum compounds is a complex process involving multiple mechanisms pertaining not only to the tumoral cell but also to the tumoral microenvironment. In this review, we discuss the molecular mechanism involved in ovarian cancer cells' resistance to platinum-based chemotherapy, focusing on the alteration of drug influx and efflux pathways, DNA repair, the dysregulation of epigenetic modulation, and the involvement of the tumoral microenvironment in the acquisition of the platinum-resistant phenotype. Furthermore, we review promising alternative treatment approaches that may improve these patients' poor prognosis, discussing current strategies, novel combinations, and therapeutic agents.