Results showed the top 20 involved signaling pathways, including the cancer pathway, Ras signaling pathway, Rap1 signaling pathway, PI3K-Akt signaling pathway, and MAPK signaling pathway, suggesting that these four exosomal miRNAs play crucial roles in metastasis and proliferation progression of ESCC. Here, AKT1 is linked to esophageal squamous cell carcinoma.