Ja Hyeon Ku¹, Lily Yu²

¹Department of Urology, Seoul National University Hospital, Seoul, Korea; ²TCR Editorial Office, AME Publishing Company

Correspondence to: Lily Yu. TCR Editorial Office, AME Publishing Company. Email: tcr@amepc.org.

Editor’s note

Translational Cancer Research (TCR) has published a number of special series in recent years, receiving overwhelming responses from academic readers around the world. Our success cannot be achieved without the contribution of our distinguished guest editors. This year TCR launched a new column, “Interviews with Guest Editors”, to better present our guest editors and to further promote the special series. We also hope to express our heartfelt gratitude for their tremendous effort and to further uncover the stories behind the special series.

The special series “Urothelial Carcinoma”(1) led by Dr. Ja Hyeon Ku (Figure 1), Dr. Hyeong Dong Yuk and Dr. Hyung Suk Kim has attracted many readers since its publication. This special series aimed to explore the diagnosis and treatment of urothelial cancer, focusing on histologic variants, molecular biomarkers, noninvasive urine tests, and novel systemic agents. At this moment, we are honored to have an interview with Dr. Ku to share his scientific career experience and insights on this special series.

Figure 1 Dr. Ja Hyeon Ku.

Expert introduction

Dr. Ja Hyeon Ku of Seoul National University Hospital, Republic of Korea, is a prominent healthcare provider at the Urology Department. His top areas of expertise are robotic surgery, artificial bladder, and urothelial cancer. He studied bladder cancer as a visiting postdoc fellow at Scott Department of Urology, Baylor College of Medicine, Houston, Texas. Dr. Ja Hyeon Ku has years of practice and experience in his field and has successfully treated complex Urothelial Cancer cases, which distinguishes him from other urologists. Dr. Ja Hyeon Ku has published over 350 peer-reviewed research articles and books. Dr. Ja Hyeon Ku has also participated in more than 30 clinical trials in the past 7 years.

Interview

TCR: What motivated you to specialize in the field of urothelial cancer?

Dr. Ku: As you know, urothelial carcinoma is one of the common cancers in the world (2) and it has an aggressive nature with high recurrence and progression rates. However, until now, urothelial carcinoma remains a malignancy with few diagnostic and treatment advances.

TCR: You highlighted the advancements in diagnostic tools such as noninvasive urinary biomarkers in the editorial (3). In light of these developments, how do you foresee these new diagnostic methods changing the landscape of urothelial cancer management?

Dr. Ku: Bladder cancer detection and follow-up is based on cystoscopy and/or cytology, but it is invasive and not perfect. Therefore, most researches have focused on urinary biomarkers. Unfortunately, however, current urinary biomarkers have lower specificity compared with cytology though these have higher detection sensitivity. Clinical benefit of urinary markers remains to be uncertain. More studies should be conducted with proper design in this field.

TCR: The research on bladder cancer is developing rapidly. From your experience, what do you believe are the biggest challenges in the development and implementation of non-invasive urinary biomarkers in the diagnosis and management of bladder cancer?

Dr. Ku: The implementation of a biomarker in clinical practice requires confirmation of its analytical validity, clinical validity, added value compared with existing makers with accepted clinical validity, and acceptability by patients but these criteria are not always considered in most studies (4). Moreover, lower specificity of urinary biomarkers leads to unnecessary cystoscopy.

TCR: The special issue covers a wide range of new topics related to urothelial carcinoma. Looking towards the future, what areas of research or treatment do you think hold the greatest promise for improving outcomes for patients with urothelial carcinoma?

Dr. Ku: Since urothelial carcinoma is a disease with significant heterogeneity, this genomic heterogeneity may be a precision oncology approaches for urothelial carcinoma. Ongoing efforts evaluating cancer genomics to overcome the current limitations such as circulating tumor cells, circulating tumor DNA, cell-free DNA, exosomes, metabolomics, and proteomics seem to be promising.

TCR: Have you recently conducted any research projects related to the topic of this series? If so, could you share some of your key findings?

Dr. Ku: Recently, I and my colleagues have created bladder organoid model and multilayer bladder assembloids (5, 6). With these models, we reported that the FOXA1-BMP-hedgehog signaling feedback axis between tumor and stroma had the important role in the control of tumor plasticity.

TCR: If given an opportunity to update this special series, what would you like to moderate, add or emphasize to provide a more comprehensive series?

Dr. Ku: If possible, I would like to moderate evolving and/or ongoing management for urothelial carcinoma including immune-checkpoint inhibitors, programmed cell death 1 and programmed cell death ligand 1 inhibitors, fibroblast growth factor receptor inhibitors, and antibody-drug conjugates.

Reference

1. Urothelial Carcinoma. Available online: https://tcr.amegroups.com/post/view/urothelial-carcinoma
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70:7-30.
3. Yuk HD, Kim HS, Ku JH. Current status of the focused series “Urothelial Carcinoma”. Transl Cancer Res 2020;9(10):6534-6536.
4. Soorojebally Y, Neuzillet Y, Roumiguié M, et al. Urinary biomarkers for bladder cancer diagnosis and NMIBC follow-up: a systematic review. World J Urol 2023;41(2):345-359.
5. Kim S, Kim Y, Kong J, et al. Epigenetic regulation of mammalian Hedgehog signaling to the stroma determines the molecular subtype of bladder cancer. Elife 2019;8:e43024.
6. Kim E, Choi S, Kang B, et al. Creation of bladder assembloids mimicking tissue regeneration and cancer. Nature 2020;588(7839):664-669.