Cervical cancer (CC) represents a major global health concern, characterized by chemoresistance and immune evasion mechanisms. Circular RNAs (circRNAs), which play a crucial role in cancer pathogenesis, particularly in the case of CC, have gained significant attention. The primary objective of this study was to investigate the functional significance of circRNAs in chemoresistant CC. A significant upregulation of circPRDM4 expression in chemoresistant CC cells. To investigate the functional consequences, we conducted circPRDM4 knockdown experiments, which resulted in the effective blockade of immune escape mechanisms employed by chemoresistant CC cells. Furthermore, circPRDM4 knockdown demonstrated a significant suppression of tumorigenesis in CC cells, highlighting its contribution to the oncogenic potential of CC. Investigating the regulatory mechanisms involved, we found that the transcriptional factor upstream stimulatory factor 1 (USF1) acts as an inducer of circPRDM4 expression. Remarkably, USF1 was found to effectively modulate CC cell immune escape via its interaction with circPRDM4. Moreover, our results revealed that USF1 is intricately involved in CC cell tumorigenesis through the regulation of circPRDM4. Collectively, our study elucidates the significant roles of circPRDM4 and its upstream regulator USF1 in chemoresistant CC cells. These findings underscore the importance of circRNAs in CC pathogenesis and provide valuable insights into the mechanisms underlying immune escape and tumorigenesis.

The present study aims to find a differential protein-coding gene caspase 12 (CASP12) in cervical cancer (CC) based on the (TCGA) database and verify its clinical diagnostic and prognostic values. The transcriptome and clinicopathological data of CC were downloaded from the TCGA database and through screening, we found that PDE2A and CASP12 were independent prognostic factors for CC patients. According to the median expression, the patients were divided into groups with high and low CASP12 and PDE2A expression. There was no difference in survival between PDE2A high and low expression groups (P=0.099), whereas there was a significant difference between CASP12 high and low expression groups (P=0.033). The serum from 68 CC patients (experimental group) and 50 healthy people (control group) was collected to detect the relative expression of CASP12 using qRT-PCR and plotted the ROC curve. The relative expression of CASP12 in the experimental group was significantly lower than in the control group (P<0.05). The area under the curve (AUC) of CASP12 was 0.865. There were statistically significant differences between CASP12 groups with high and low expression in terms of differentiation, lymph node metastasis, tumor size, FIGO staging, and clinical outcomes (P<0.05), but not in terms of age, HPV types and pathological types (P>0.05). The 3-year survival in the CASP12 low expression group was significantly worse than in the CASP12 high expression group (P=0.028). In conclusion, the expression level of CASP12 can be used as a diagnostic and prognostic biomarker for patients with CC.