我们的目标是通过使用三级化疗反应评分（CRS）来验证新辅助化疗（NACT）对卵巢癌（OC）的病理反应（pR）是否与临床结果相关，并可以作为生存的替代标志物。我们进行了一项回顾性研究，包括接受NACT的FIGO III/IV期OC患者，根据从盲肠膜腔组织中获取的组织标本评定反应为无或轻微（CRS 1）、部分（CRS 2）或完全/近完全（CRS 3）的pR。考虑年龄、FIGO期、切除程度、BRCA状态以及新辅助使用贝伐单抗进行了单变量和多变量生存分析。133例病例中，CRS 1、2和3的分别为41例（31%）、62例（47%）和30例（22%）。NACT的反应与进展生存期（PFS，p<0.001）和总生存期（OS，p=0.011）有明显改善相关。与无或轻微反应（CRS 1）相比，完全/近完全病理反应（CRS 3）与PFS明显改善（中位生存期24.8 vs. 12.5个月，未调整风险比（HR）0.28 [95% CI 0.15-0.54]，p<0.001；调整危险比（aHR）0.31 [95% CI 0.14-0.72]，p=0.007）和OS（中位生存期63.3 vs. 32.1个月，未调整HR 0.27 [95% CI 0.10-0.68]，p=0.006；aHR 0.32 [95% CI 0.09-1.11]，p=0.072）相关联。我们在OC中验证了三级CRS在评估NACT的病理反应上的应用，并证明其与BRCA状态或新辅助贝伐单抗使用的预后独立性。提高pR率可能是NACT在OC中的有益目标，可望改善生存。CRS可作为OC临床试验中有用的终点。版权所有 © 2023，Elsevier Inc. 出版。

We aimed to validate whether pathologic response (pR) to neoadjuvant chemotherapy (NACT) using a three-tier chemotherapy response score (CRS) is associated with clinical outcome in ovarian cancer (OC) and could be used as surrogate marker for survival.We conducted a retrospective study of OC patients with FIGO stage III/IV disease who received NACT and graded response as no or minimal (CRS 1), partial (CRS 2), or complete/near-complete (CRS 3) pR using tissue specimens obtained from omentum. Uni- and multivariate survival analyses were performed accounting for age, FIGO stage, debulking and BRCA status as well as neoadjuvant use of bevacizumab.CRSs 1, 2 and 3 were found in 41(31%), 62 (47%) and 30 (22%) of the 133 examined cases. Response to NACT was associated with significantly improved progression-free (PFS, p < 0.001) and overall survival (OS, p = 0.011). Complete/ near-complete pathologic response (CRS3) was associated with improved PFS (median 24.8 vs. 12.5 months, unadjusted HR 0.28 [95%CI 0.15-0.54], p < 0.001; adjusted hazard ration (aHR) 0.31 [95% CI 0.14-0.72], p = 0.007) and OS (median 63.3 vs. 32.1 months, unadjusted HR 0.27 [95%CI 0.10-0.68], p = 0.006; aHR 0.32 [95% CI 0.09-1.11], p = 0.072) when compared to no or minimal response (CRS1).We validate a three-tier CRS for assessment of pathologic response to NACT in OC and demonstrate its prognostic independence of BRCA status or neoadjuvant bevacizumab use. Improving pR rates may be a useful goal of NACT in OC with the expectation of improved survival. The CRS may be a useful endpoint in clinical trials in OC.Copyright © 2023. Published by Elsevier Inc.