Exosome-orchestrated network in gastric cancer: mechanisms, immune regulation, biomarkers and therapeutic vehicles.

Gastric cancer (GC) is a malignancy with high global incidence and mortality, and its poor prognosis and therapeutic failure are largely attributable to a complex tumor microenvironment. Extracellular vesicles (EVs) mediate intercellular molecular communication and are deeply involved in the initiation and progression of GC. Here, we focus on exosomes, the most thoroughly studied EV subtype (30-150 nm), and examine their biological roles in GC and their potential for clinical translation. We construct an exosome-derived molecular network of GC progression across six dimensions: promoting tumor cell proliferation, orchestrating an immunosuppressive microenvironment, inducing tumor angiogenesis, remodeling the extracellular matrix, guiding metastasis, and mediating drug resistance. In this review, we systematically summarize exosome-derived non-coding RNAs and proteins as biomarkers for early detection and prognosis of GC. Moreover, emerging strategies targeting exosomes or employing exosomes as delivery vehicles are discussed. Finally, we address current challenges in exosome research and propose future directions. This review aims to serve as a reference for basic research and clinical translation in GC, emphasizing that deciphering exosome-mediated intercellular dialogue is essential for understanding the molecular underpinnings of tumor progression and developing novel intervention strategies.