For 40 years intravesical Bacillus Calmette-Guérin (BCG) instillation has been used as a non-specific immunotherapy to recruit immune cells into the bladder to reduce the recurrence and progression rates of high-risk nonmuscle-invasive bladder cancer (NMIBC).1 Unfortunately, the failure rate was close to 50% and the immune escape mechanism of cancer cells remained long misunderstood.2 However, recent advances in immuno-oncology with the discovery of immune checkpoints (PD-L1/PD-1) as a mechanism of immune escape from cancer cells could explain the failures of BCG.3 In this study, we assessed the association of PD-L1 expression in tumor cells and microenvironment tissue and disease-free survival in high-risk nonmuscle-invasive bladder cancer treated with induction plus maintenance of BCG.