{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T20:05:51Z","timestamp":1769630751665,"version":"3.49.0"},"reference-count":48,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Cervical cancer remains a significant global health burden, underscoring the imperative for refined diagnostic and prognostic methodologies. This study aimed to evaluate the potential of extracellular vesicles (EVs) as non-invasive biomarkers for cervical cancer, focusing on diagnosis and prognosis. Methods: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines to assess the diagnostic and prognostic accuracy of EV-based biomarkers. We searched PubMed, EMBASE, and Web of Science for relevant studies. Twelve articles met the inclusion criteria: eight related to diagnostic accuracy, three to prognosis, and one to both outcomes. Six studies met the criteria for meta-analysis. We used a random-effects model to synthesise diagnostic data, while prognostic data were synthesised narratively. Results: The meta-analysis yielded a pooled area under the receiver operating characteristic curve (AUC) of 0.87 (95% CI 0.80\u20130.92) for EVs in the diagnosis of cervical cancer, indicating high accuracy. The evaluated diagnostic biomarkers were primarily non-coding RNAs. For prognosis, data heterogeneity precluded quantitative synthesis; however, individual studies identified diverse EV-associated molecules correlated with recurrence and survival. GRADE assessment indicated a high risk of bias and heterogeneity across studies. Conclusions: Extracellular vesicles demonstrate robust promise as diagnostic biomarkers for cervical cancer; however, their prognostic utility remains inconclusive due to methodological and clinical heterogeneity. Future research must prioritise the standardisation of isolation protocols and the execution of large-scale, prospective studies to validate EV biomarkers for clinical application. Systematic Review Registration: PROSPERO, identifier: CRD420251014411.<\/jats:p>","DOI":"10.3390\/cancers17243945","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T14:22:40Z","timestamp":1765376560000},"page":"3945","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exosomes as Emerging Non-Invasive Biomarkers of Cervical Cancer: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"17","author":[{"given":"Fernanda","family":"Santos","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Gynaecology Department, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Coimbra Academic and Clinical Centre, 3000-075 Coimbra, Portugal"},{"name":"Gynaecology Department, ULS\u2014Coimbra Hospital and University Centre of Coimbra, 3004-561 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0015-8604","authenticated-orcid":false,"given":"Francisco A.","family":"Caramelo","sequence":"additional","affiliation":[{"name":"Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal"},{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"}]},{"given":"Jorge M. P.","family":"Tomaz","sequence":"additional","affiliation":[{"name":"Blood and Transfusion Medicine Department at ULS Coimbra, ULS\u2014Coimbra Hospital and University Centre of Coimbra, 3004-561 Coimbra, Portugal"}]},{"given":"Magda M.","family":"Santana","sequence":"additional","affiliation":[{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, 3004-504 Coimbra, Portugal"}]},{"given":"Rui J.","family":"Nobre","sequence":"additional","affiliation":[{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Institute for Interdisciplinary Research (IIIUC), University of Coimbra, 3030-789 Coimbra, Portugal"},{"name":"ViraVector, University of Coimbra, 3004-504 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5831-3307","authenticated-orcid":false,"given":"Luis P.","family":"Almeida","sequence":"additional","affiliation":[{"name":"Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Centre for Neuroscience and Cell Biology (CNC), University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Institute for Interdisciplinary Research (IIIUC), University of Coimbra, 3030-789 Coimbra, Portugal"},{"name":"ViraVector, University of Coimbra, 3004-504 Coimbra, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8396-2667","authenticated-orcid":false,"given":"Margarida","family":"Figueiredo-Dias","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Gynaecology Department, University of Coimbra, 3004-504 Coimbra, Portugal"},{"name":"Coimbra Academic and Clinical Centre, 3000-075 Coimbra, Portugal"},{"name":"Gynaecology Department, ULS\u2014Coimbra Hospital and University Centre of Coimbra, 3004-561 Coimbra, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.ejca.2021.07.039","article-title":"The European cancer burden in 2020, Incidence and mortality estimates for 40 countries and 25 major cancers","volume":"157","author":"Dyba","year":"2021","journal-title":"Eur. 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