The role of CTSE in BLCA is paradoxical, as it was found in a study by Wild, et al.16 that CTSE is predominantly overexpressed in NMIBC (pTa, pT1, and pT2), and its expression in pTa stage tumors correlates with tumor progression characteristics, but overall OS was significantly longer in BLCA patients with strong CTSE immunohistochemistry positivity than in the CTSE-negative group (178 vs. 140 months, p=0.003), which is similar to the results of the present study. Here, CTSE is linked to bladder transitional cell carcinoma.