Investigation of risk factors, PKM2 & Stat3 biomarkers, and psychological impact in high-risk HPV-positive women undergoing cervical cancer screening in outpatient clinics
Abstract
The aim of the present study was to analyze the influencing factors of cervical lesions with positive human papillomavirus (HPV) infections in women and the significance of combining pyruvate kinase M2 (PKM2) and signal transducer and activator of transcription 3 (Stat3) in cervical cancer screening. The research results are interpreted from a psychosocial perspective to provide new perspectives for the comprehensive management of cervical cancer. The study analyzed data from 149 women who underwent cervical cancer screening at The First People’s Hospital of Yuhang District, Hangzhou Hospital, between October and December 2024. Participants were tested for HPV infection using PCR-reverse dot hybridization and underwent liquid-based cytology assessment. Biomarker analysis of PKM2 and Stat3 levels in cervical secretions was performed using chemiluminescence. Statistical analyses, including logistic regression and ROC curve analysis, were conducted to evaluate risk factors for high-risk HPV infection and assess the predictive value of PKM2 and Stat3 in cervical cancer screening. In the univariate analysis, the number of sexual partners, frequency of sexual activity, frequency of condom use, reproductive tract inflammation, number of pregnancies, PKM2, and Stat3 were found to be associated with the occurrence of cervical cancer (P < 0.05). Logistic multiple regression analysis indicated that PKM2, Stat3, reproductive tract inflammation, and frequency of sexual activity had a significant impact. From a psychosocial perspective, sexual behavior-related factors are not only biological risk factors but may also have a negative impact on patients’ mental state and quality of life, such as anxiety, depression, and other emotional problems. Additionally, in receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for cervical secretion screening for cervical cancer was higher than for any other single indicator (P < 0.05), providing a useful reference for clinical screening of high-risk cervical cancer populations and improving patient prognosis. The results of this study also suggest that sexual behavior-related factors may have an impact on patients’ psychology and quality of life, further emphasizing the importance of comprehensive consideration of psychosocial factors in cervical cancer screening and management.
Copyright (c) 2025 Author(s)
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. Gao B, Liou YL, Yu Y, et al. The characteristics and risk factors of human papillomavirus infection: an outpatient population-based study in Changsha, Hunan. Scientific Reports. 2021; 11(1). doi: 10.1038/s41598-021-94635-1
2. Yang D, Zhang J, Cui X, et al. Risk Factors Associated With Human Papillomavirus Infection, Cervical Cancer, and Precancerous Lesions in Large-Scale Population Screening. Frontiers in Microbiology. 2022; 13. doi: 10.3389/fmicb.2022.914516
3. Babi A, Issa T, Issanov A, et al. Prevalence of high-risk human papillomavirus infection among Kazakhstani women attending gynecological outpatient clinics. International Journal of Infectious Diseases. 2021; 109: 8-16. doi: 10.1016/j.ijid.2021.06.006
4. Chinese Society of Pathology, Women’s Reproductive System Disease Group. Guidelines for the pathological diagnosis of cervical cancer and precancerous lesions. Chinese Journal of Pathology. 2019; 48(4): 265-269.
5. Shamaun S, Jaleel R, Gull Y, et al. Knowledge and Attitude of Cervical Cancer Screening and Vaccination in Patients Attending Gynecology Outpatient Clinic at a Tertiary Care Hospital in Pakistan. South Asian Journal of Cancer. 2022; 12(01): 017-022. doi: 10.1055/s-0042-1751093
6. Wang H, Nie K, Liu Z, et al. Analysis of risk factors associated with cervical HPV infection and their effects on female sexual function and anxiety: a multicenter cross-sectional study based on Chinese women. Frontiers in Oncology. 2024; 14. doi: 10.3389/fonc.2024.1468160
7. Phaiphichit J, Paboriboune P, Kunnavong S, et al. Factors associated with cervical cancer screening among women aged 25–60 years in Lao People’s Democratic Republic. Yi S, ed. PLOS ONE. 2022; 17(4): e0266592. doi: 10.1371/journal.pone.0266592
8. Yan X, Shen L, Xiao Y, et al. Prevalence, characteristics, and distribution of HPV genotypes in women from Zhejiang Province, 2016–2020. Virology Journal. 2021; 18(1). doi: 10.1186/s12985-021-01676-z
9. Wright JD, Chen L, Tergas AI, et al. Overuse of Cervical Cancer Screening Tests Among Women With Average Risk in the United States From 2013 to 2014. JAMA Network Open. 2021; 4(4): e218373. doi: 10.1001/jamanetworkopen.2021.8373
10. Abdi M, Tamiru A, Tilahun T, et al. Factors associated with human papillomavirus infections among women living with HIV in public health facilities in Western Oromia, Ethiopia. BMC Women’s Health. 2024; 24(1). doi: 10.1186/s12905-024-03249-y
11. Erdogan M, Cihan F, Kutlu R, et al. Awareness of cervical cancer, human papilloma virus (HPV) and HPV vaccination among women in a cancer screening, early diagnosis and education center. Annals of Medical Research. 2021; 28(9): 1735. doi: 10.5455/annalsmedres.2020.10.1041
12. Rai R, Sehgal R, Singhal S, et al. Cervical Cancer Screening Coverage at Tertiary Care Institutes Across India. Asian Pacific Journal of Cancer Prevention. 2023; 24(12): 4269-4275. doi: 10.31557/apjcp.2023.24.12.4269
13. Chen J, Zhang R, Xu W, et al. Knowledge and Practices Regarding Human Papillomavirus and Cervical Cancer Screening Among Women in Low-Income Areas of China: A Cross-Sectional Study. Cureus. 2024. doi: 10.7759/cureus.55930
14. Vaidya JS, Bulsara M, Wenz F, Sperk E, Massarut S, Alvarado M, Williams NR, Brew-Graves C, Bernstein M, Holmes D, Vinante L, Pigorsch S, Lundgren S, Uhl V, Joseph D, Tobias JS; TARGIT-A authors. The TARGIT-A Randomized Trial: TARGIT-IORT Versus Whole Breast Radiation Therapy: Long-Term Local Control and Survival. Int J Radiat Oncol Biol Phys. 2023 Jan 1;115(1):77-82. doi: 10.1016/j.ijrobp.2022.08.029. Epub 2022 Aug 23. PMID: 35998867.
15. Lv Z, He X, Li Z, et al. Outcomes and associated factors of cervical human papillomavirus infection among 608 women in Shenzhen, China, 2018–2023. Frontiers in Public Health. 2025; 12. doi: 10.3389/fpubh.2024.1523839
16. Li J, Lai H, Qin H, et al. Current status of high-risk HPV infection and correlation with multiple infections in cervical lesions in Western Guangzhou. Frontiers in Medicine. 2024; 11. doi: 10.3389/fmed.2024.1252073
17. Nang DW, Tukirinawe H, Okello M, et al. Prevalence of high-risk human papillomavirus infection and associated factors among women of reproductive age attending a rural teaching hospital in western Uganda. BMC Women’s Health. 2023; 23(1). doi: 10.1186/s12905-023-02342-y
18. Hirani S, Khan S, Akram S, et al. Knowledge, awareness, and practices of cervical cancer, its risk factors, screening, and prevention among women in Karachi, Pakistan. European Journal of Cancer Prevention. 2020; 30(1): 97-102. doi: 10.1097/cej.0000000000000590
19. Oneko O, J Mahande M, Amour C, et al. Willingness to HPV self-sampling for cervical cancer screening and its predictors among women attending outpatient clinics in Meru District, Arusha Region, Northern Tanzania. African Health Sciences. 2022; 22(2): 97-106. doi: 10.4314/ahs.v22i2.12
20. Macios A, Didkowska J, Wojciechowska U, et al. Risk factors of cervical cancer after a negative cytological diagnosis in Polish cervical cancer screening programme. Cancer Medicine. 2021; 10(10): 3449-3460. doi: 10.1002/cam4.3857
21. Plisko O, Zodzika J, Jermakova I, et al. Aerobic Vaginitis—Underestimated Risk Factor for Cervical Intraepithelial Neoplasia. Diagnostics. 2021; 11(1): 97. doi: 10.3390/diagnostics11010097
22. Ndateba I, Kabatsinda A, Ndabarora E. Uptake of Cervical Cancer Screening and Associated Factors Among Women Attending Outpatient Services in Rwamagana Hospital, Rwanda. Rwanda Journal of Medicine and Health Sciences. 2021; 4(3): 387-397. doi: 10.4314/rjmhs.v4i3.8
23. Worku E, Yigizaw G, Admassu R, et al. Prevalence and risk factors associated with precancerous and cancerous cervical lesions among HIV-infected women in University of Gondar specialized comprehensive referral hospital, Northwest Ethiopia: cross-sectional study design. BMC Women’s Health. 2024; 24(1). doi: 10.1186/s12905-024-03174-0
24. Zhang H, Zhang S. Prevalence and genotype distribution of human papillomavirus infection among female outpatients in Northeast China: a population-based survey of 110,927 women. Archives of Gynecology and Obstetrics. 2022; 308(1): 35-41. doi: 10.1007/s00404-022-06653-7
25. Taye BT, Mihret MS, Muche HA. Risk factors of precancerous cervical lesions: The role of women’s socio-demographic, sexual behavior and body mass index in Amhara region referral hospitals; case-control study. Spradley FT, ed. PLOS ONE. 2021; 16(3): e0249218. doi: 10.1371/journal.pone.0249218
26. Bhattacharya A, Chakraborty K, Saha P, et al. Cervical cytology abnormalities and associated genotype patterns of High-Risk HPV Infection in Women of Tripura, North-East India: A Hospital-Based Study. American Journal of Epidemiology. 2024. doi: 10.1093/aje/kwae364
27. Xiao Y, Liu R, Wang S, et al. Predicting the risk of high-grade precancerous cervical lesions based on high-risk HPV typing in Changsha China. BMC Women’s Health. 2025; 25(1). doi: 10.1186/s12905-025-03562-0
