Prognosis in high-grade T1 bladder cancer: host immune response and tumour infiltrating lymphocytes

Bladder cancer is a heterogeneous disease that poses a challenge to the treating clinician. In non-muscle-invasive bladder cancer (NMIBC), the EORTC risk tables have helped stratify patients into low, intermediate and high-risk groups, but are now over a decade old (1). Within the high-risk group lies high-grade T1 (HGT1) disease, a variable group of patients with tumors that can behave similarly to muscle-invasive bladder cancer. Rates of progression to muscle-invasive disease and metastases vary between 25% and 73%, and long-term follow-up suggests up to 25% of patients may die from bladder cancer (2). Management of these patients can vary from immunotherapy to radical cystectomy, and a current unmet research need lies in stratifying patients who would most benefit from radical treatment.