Non‑coding RNAs as Emerging Biomarkers in HPV‑Associated Cervical Disease: A Narrative Review of Molecular Mechanisms and Clinical Perspectives

Cervical cancer remains a significant global health challenge, predominantly driven by persistent infection with high-risk human papillomavirus (HPV) genotypes. While conventional screening and vaccination strategies have reduced disease incidence, some limitations as sensitivity, accessibility, and prognostic accuracy underscore the need for novel biomarkers. Emerging evidence highlights the role of non-coding RNAs (ncRNAs)—including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs)—in HPV-associated cervical carcinogenesis. These molecules plays multiple roles in cell proliferation, apoptosis, immune evasion, and ferroptosis suppression. Notably, HPV-derived circE7 and dysregulated host ncRNAs such as miR-21, miR-34a, MALAT1, and HOTAIR have demonstrated diagnostic and prognostic potential. Furthermore, recent discoveries of lncRNA-encoded oncopeptides, particularly TUBORF, which modulates ferroptosis via the ESCO1-IRGQ axis, unveil novel therapeutic targets. This narrative review synthesizes current insights into the molecular mechanisms and clinical perspectives of ncRNAs in HPV-associated cervical disease, emphasizing their promise as biomarkers for early detection, prognosis, and therapeutic intervention. Future validation in large-scale, multi-omics-integrated clinical studies is warranted to enable their translation into routine practice.