对于诊断为局部晚期宫颈癌 (LACC) 的女性来说，新辅助化疗 (NACT) 是一种可行的治疗选择。然而，影响病理反应的因素仍存在争议。我们收集了 185 例 LACC 患者接受 NACT 前后的配对标本并进行组织学评估。从整个队列中选择8个预处理的新鲜组织进行免疫基因表达谱分析。通过综合评估瘤床中存活肿瘤、炎性间质、纤维化间质和坏死的百分比，建立了新的病理分级系统。然后，185 名患者在 NACT 后被分为良好病理反应（GPR）组或不良病理反应（PPR）组，其中 134 名患者（72.4％，134/185）实现 GPR。治疗前增加的肿瘤浸润淋巴细胞 (TIL) 和肿瘤浸润淋巴细胞体积 (TILV) 与 GPR 相关，其中 TILV 成为 GPR 的独立预测因素。此外，CIBERSORT 分析显示 cPR 组和非 cPR 组之间免疫标志物的表达存在显着差异。此外，与 PPR 相比，GPR 中 CD8  T 细胞密度显着升高，FOXP3  T 细胞密度显着降低。重要的是，表现出 GPR 或炎症类型的患者表现出总生存期和无病生存期的改善。值得注意的是，基质类型是多变量分析中的独立预后因素。我们的研究表明，治疗前标本中升高的 TILV 可能预示着对 NACT 的良好反应，同时将治疗后标本中的间质类型确定为独立的预后因素。此外，我们在 NACT 患者中提出了这种病理分级系统，这可能会提供对治疗反应和预后的更全面的了解。© 2024。作者。

Neoadjuvant chemotherapy (NACT) is a viable therapeutic option for women diagnosed locally advanced cervical cancer (LACC). However, the factors influencing pathological response are still controversial. We collected pair specimens of 185 LACC patients before and after receiving NACT and conducted histological evaluation. 8 fresh tissues pre-treatment were selected from the entire cohort to conducted immune gene expression profiling. A novel pathological grading system was established by comprehensively assessing the percentages of viable tumor, inflammatory stroma, fibrotic stroma, and necrosis in the tumor bed. Then, 185 patients were categorized into either the good pathological response (GPR) group or the poor pathological response (PPR) group post-NACT, with 134 patients (72.4%, 134/185) achieving GPR. Increasing tumor-infiltrating lymphocytes (TILs) and tumor-infiltrating lymphocytes volume (TILV) pre-treatment were correlated with GPR, with TILV emerging as an independent predictive factor for GPR. Additionally, CIBERSORT analysis revealed noteworthy differences in the expression of immune makers between cPR and non-cPR group. Furthermore, a significantly heightened density of CD8 + T cells and a reduced density of FOXP3 + T cells were observed in GPR than PPR. Importantly, patients exhibiting GPR or inflammatory type demonstrated improved overall survival and disease-free survival. Notably, stromal type was an independent prognostic factor in multivariate analysis. Our study indicates the elevated TILV in pre-treatment specimens may predict a favorable response to NACT, while identifying stromal type in post-treatment specimens as an independent prognostic factor. Moreover, we proposed this pathological grading system in NACT patients, which may offer a more comprehensive understanding of treatment response and prognosis.© 2024. The Author(s).