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Background  To reveal roles of reactive oxygen species (ROS) status in chemotherapy resistance and to develop a ROS scoring system for prognosis prediction in ovarian cancer.    Methods  We tested the sensitizing effects of ROS elevating drugs to cisplatin (cDDP) in ovarian cancer both in vitro and in vivo. A ROS scoring system was developed using The Cancer Genome Atlas (TCGA) database of ovarian cancer. The associations between ROS scores and overall survival (OS) were analyzed in TCGA, Tothill dataset, and our in-house dataset (TJ dataset).    Results  ROS-inducing drugs increased cisplatin-induced ovarian cancer cell injury in vitro and in vivo. ROS scoring system was established using 25 ROS-related genes. Patients were divided into low (scores 0–12) and high (scores 13–25) score groups. Improved patient survival was associated with higher scores (TCGA dataset hazard ratio (HR) = 0.43,  P  < 0.001; Tothill dataset HR = 0.65,  P  = 0.022; TJ dataset HR = 0.40,  P  = 0.003). The score was also significantly associated with OS in multiple datasets (TCGA dataset r 2  = 0.574,  P  = 0.032; Thothill dataset r 2  = 0.266,  P  = 0.049; TJ dataset r 2  = 0.632,  P  = 0.001) and with cisplatin sensitivity in ovarian cancer cell lines (r 2  = 0.799,  P  = 0.016) when used as a continuous variable. The scoring system showed better prognostic performance than other clinical factors by receiver operating characteristic (ROC) curves (TCGA dataset area under the curve (AUC) = 0.71 v.s. 0.65, Tothill dataset AUC = 0.73 v.s. 0.67, TJ dataset AUC = 0.74 v.s. 0.66).    Conclusions  ROS status is associated with chemotherapy resistance. ROS score system might be a prognostic biomarker in predicting the survival benefit from ovarian cancer patients.

A reactive oxygen species scoring system predicts cisplatin sensitivity and prognosis in ovarian cancer patients