How Advanced Are Extracellular Vesicles in Renal Cell Carcinoma? For Diagnostic and Therapeutic Frontiers.

Renal cell carcinoma (RCC), a prevalent malignant tumor of the urinary system, presents significant challenges in early diagnosis and treatment. The invasiveness of traditional tissue biopsies and the limitations of imaging techniques necessitate the exploration of novel biomarkers through liquid biopsy. Extracellular vesicles (EVs), functioning as natural nanoscale carriers, encapsulate a variety of tumor-derived molecules and exhibit distinctive potential in non-invasive diagnosis, regulation of the tumor microenvironment (TME), and resistance to treatment in RCC. Serum- and urine-derived EVs can effectively differentiate RCC patients from healthy individuals by utilizing specific biomarkers, such as miRNAs, proteins, and snoRNAs. They can predict tumor staging, metastasis, and prognosis. TME is reshaped by EVs through the transmission of immunosuppressive factors and pro-angiogenic molecules, facilitating immune escape and the formation of pre-metastatic niches. Furthermore, the drug resistance mechanisms mediated by EVs provide new insights for targeted therapy, and their application as drug carriers demonstrates therapeutic potential. Nonetheless, the clinical translation of EVs faces several technical challenges, including the standardization of isolation techniques, inadequate validation of biomarkers, and the lack of large-scale clinical studies. Future efforts are focused on integrating multi-omics analysis, AI-assisted diagnosis, and novel isolation techniques to facilitate the transition of EVs from the laboratory to clinical application. Overall, EVs hold significant promise for the precision diagnosis and treatment of RCC; however, their widespread application necessitates systematic validation and technological innovation.