Exosomal non-coding RNAs mediate tumor microenvironment crosstalk and enable liquid biopsy applications in bladder cancer

The high recurrence rate and progression propensity of bladder cancer have long presented substantial challenges to clinical management. Within this context, studies have reported that the tumor microenvironment (TME) acts as a complex, interconnected system, mediating dynamic crosstalk among diverse cellular components that play key roles in promoting tumor progression. Accordingly, emerging evidence suggests that the mechanisms governing intercellular communication are closely involved in the initiation and progression of bladder cancer. Exosomal non-coding RNAs (exosomal ncRNAs), which have emerged as putative key mediators of intercellular communication and have attracted growing research attention, represent an active area of ongoing investigation in bladder cancer research. However, a comprehensive synthesis of these findings remains incomplete, and the clinical translation potential of these molecules remains largely underexplored. This narrative review systematically synthesizes the documented dual roles of exosomal ncRNAs in bladder cancer by integrating relevant literature from PubMed and Web of Science up to 2025, with a focus on studies published in the past five years. Specifically, accumulating evidence indicates that two core functions of these molecules have been extensively studied: First, these vesicles are associated with malignant progression by mediating reciprocal crosstalk between tumor cells and stromal components within the TME, including macrophages, fibroblasts, and mesenchymal stem cells. Second, their well-documented high stability and specificity have led to proposals that they could serve as promising molecular biomarkers; exosomal ncRNAs detected in bodily fluids such as urine have been proposed to hold considerable potential for non-invasive diagnosis and prognostic stratification. Overall, this work focuses on the roles of exosomal ncRNAs in bladder cancer TME remodeling and non-invasive liquid biopsy applications, aiming to establish a comprehensive framework to support future research and clinical translation.