胃肠道癌症仍然是一个全球性的重大健康负担。推进对癌症发生机制的理解，找到可靠的生物标志物，并发展精准治疗策略，是这一领域的紧迫目标。外泌体是大多数细胞释放的小的膜囊泡，常携带功能性生物分子，包括非编码RNA（ncRNA），这些分子是通过外泌体特异性排序和封装的。外泌体介导的通讯包括肿瘤细胞或基质细胞释放外泌体及其被附近或远程接受细胞吸收。这些外泌体内的生物活性物质对接受细胞产生深远影响，导致肿瘤微环境（TME）中的重要改变和胃肠道肿瘤行为的不同变化。由于可以从各种体液中分离外泌体，外泌体中的ncRNA显示出作为不同胃肠道癌症液体活检指标的巨大潜力，包括血液、腹水、唾液或胆汁样本。此外，外泌体越来越被认为是基于ncRNA的治疗干预的天然传递工具。在本综述中，我们阐明了ncRNA富集的外泌体生成和摄取过程，审视了外泌体介导的ncRNA调控和功能性作用在胃肠道肿瘤微环境和肿瘤行为中的区域间相互作用，并探讨了它们在诊断、预后和治疗中的潜在临床效益。版权所有 © 2023 Elsevier Ltd.

Gastrointestinal cancer remains a significant global health burden. The pursuit of advancing the comprehension of tumorigenesis, along with the identification of reliable biomarkers and the development of precise therapeutic strategies, represents imperative objectives in this field. Exosomes, small membranous vesicles released by most cells, commonly carry functional biomolecules, including noncoding RNAs (ncRNAs), which are specifically sorted and encapsulated by exosomes. Exosome-mediated communication involves the release of exosomes from tumor or stromal cells and the uptake by nearby or remote recipient cells. The bioactive cargoes contained within these exosomes exert profound effects on the recipient cells, resulting in significant modifications in the tumor microenvironment (TME) and distinct alterations in gastrointestinal tumor behaviors. Due to the feasibility of isolating exosomes from various bodily fluids, exosomal ncRNAs have shown great potential as liquid biopsy-based indicators for different gastrointestinal cancers, using blood, ascites, saliva, or bile samples. Moreover, exosomes are increasingly recognized as natural delivery vehicles for ncRNA-based therapeutic interventions. In this review, we elucidate the processes of ncRNA-enriched exosome biogenesis and uptake, examine the regulatory and functional roles of exosomal ncRNA-mediated intercellular crosstalk in gastrointestinal TME and tumor behaviors, and explore their potential clinical utility in diagnostics, prognostics, and therapeutics.Copyright © 2023. Published by Elsevier Ltd.