BACKGROUND: Esophageal squamous cell carcinoma (ESCC) is one of the most malignant cancers in the world, which seriously affects the survival and quality of life of patients. Aberrant expression of microRNAs plays an important role in the occurrence and progression of cancer, while exosomes usually act as the transmission of intercellular substances (including miRNAs). The objective of this study was to investigate the relationship between the expression of exosomal miR-148a and ESCC. METHODS: Real Time-quantitative Polymerase Chain Reaction (qRT-PCR) was used to evaluate the expression level of miR-148a. cell counting kit-8(CCK-8) and transwell assays are used to detect the proliferation and invasion of cancer cells. Kaplan-Meier method was used to calculate the survival rate of ESCC patients. RESULTS: The survival rate of ESCC patients was significantly separated by the expression level of exosomal miR-148a, and the overall survival time of patients with high expression of exosomal miR-148a was significantly higher than that of the group with low expression. In the cell function test, the expression of miR-148a in ESCC cell lines was significantly lower than that in normal cell lines. Overexpression of miR-148a significantly reduced the proliferation, migration and invasion of cancer cells compared with the control group. CONCLUSIONS: Conclusions: miR-148a can inhibit the proliferation, migration, and invasion of cancer cells, and patients with high expression of exosome miR-148a in ESCC patients have a longer survival, suggesting that exosome miR-148a can inhibit cancer progression, and may be used as an indicator for the diagnosis and prognosis of ESCC.