Abstract Ovarian cancer is one of the most prevalent malignancies in women, with over 70% of patients diagnosed at advanced stages (III–IV) due to a lack of early symptoms. Neoadjuvant chemotherapy (NACT) is frequently employed to alleviate systemic symptoms and prepare patients for surgery. However, no objective method currently exists to accurately assess its efficacy. Raman spectroscopy (RS), an analytical technique that detects molecular vibrations, offers a rapid, non-invasive, and cost-effective means of evaluation. This study aims to determine whether RS can serve as a novel approach for assessing the impact of NACT on fresh ovarian tissues. Fresh ovarian tissues were collected from patients treated at our hospital between September 2021 and November 2023; additionally, fresh normal ovarian tissues were obtained from six patients undergoing unrelated surgeries (the control group). The Raman spectra of different groups were analyzed using a partial least squares discriminant analysis model for interpretation. We observed that characteristic peaks at 673 and 1223 cm−1 appeared exclusively in IDS + NACT and normal control tissue maps, while the peak at 758 cm−1 was unique to the primary debulking surgery map. Following NACT, significant reductions in tissue intensity were noted at key characteristic peaks: glycogen at 477 cm−1 (P= 0.028), phenylalanine at 1004 cm−1 (P= 0.039), nucleic acids at 1342 cm−1 (P< 0.001), and lipids at 1446 cm−1 (P < 0.001). Conversely, a significant increase in amide III (α-helix) protein peak intensity was observed (P < 0.001). The results demonstrate that RS can effectively differentiate benign from malignant ovarian tissue characteristics while sensitively revealing microscopic changes in early-stage ovarian cancer before and after NACT. As an innovative method for evaluating NACT efficacy, it provides objective insights into molecular morphology that enhance our understanding of disease progression and treatment outcomes.
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