Background/Objectives: Early treatment assessment in metastatic renal cell carcinoma (mRCC) remains challenging due to the limited accuracy of current imaging methods. Given prostate-specific membrane antigen (PSMA) overexpression in mRCC, PSMA PET is a promising approach. Despite numerous studies on PSMA imaging in mRCC, data on PSMA uptake changes during systemic therapy are scarce. We analyzed PSMA uptake on PET after treatment initiation in mRCC patients.Methods: A retrospective single-center analysis of mRCC patients who underwent [18F]PSMA-1007 PET/CT before (PET1) and at a mean of 9.5 weeks after (PET2) starting systemic therapy was conducted. PSMA uptake in metastatic lesions was compared by region and RCC subtype. Uptake differences between PET1and PET2were analyzed using an unpairedt-test.Results: This study included 25 patients (mean age 65.2 ± 14.7 years; 20 male) with mRCC. A total of 113 (PET1) and 48 (PET2) metastases were assessed. Lymph node metastases showed stable PSMA uptake (median SUVmax) after treatment (7.8 vs. 7.7,p= 0.77), while uptake by bone (6.4 vs. 12.4,p= 0.03) and lung metastases (4.5 vs. 8.1,p= 0.004) increased significantly. SUV stability in lymph nodes was independent of RCC subtype (ccRCC:p= 0.48, pRCC:p> 0.99). Bone (6.6 vs. 15.9,p= 0.008) and lung metastases (4.8 vs. 8.1,p= 0.02) had higher PSMA uptake in ccRCC, unlike pRCC (bone: 6.2 vs. 6.0,p= 0.86).Conclusions: Alterations of PSMA-radioligand uptake are seen in bone and pulmonary metastases but not in lymph node metastases after initiation of systemic treatment in patients with mRCC. ccRCC has a higher PSMA uptake than other RCC subtypes.
背景/目的：由于现有影像学方法准确性有限，转移性肾细胞癌（mRCC）的早期疗效评估仍具挑战性。鉴于前列腺特异性膜抗原（PSMA）在mRCC中过表达，PSMA PET成像成为颇具前景的评估手段。尽管已有大量关于mRCC中PSMA成像的研究，但关于全身治疗期间PSMA摄取变化的数据仍较为匮乏。本研究旨在分析mRCC患者治疗开始后PET成像中PSMA的摄取变化。 方法：本研究为一项回顾性单中心分析，纳入的mRCC患者在全身治疗开始前（PET1）及开始后平均9.5周（PET2）接受了[18F]PSMA-1007 PET/CT检查。按区域和肾细胞癌亚型对转移病灶的PSMA摄取进行比较。采用非配对t检验分析PET1与PET2之间的摄取差异。 结果：本研究共纳入25例mRCC患者（平均年龄65.2 ± 14.7岁；男性20例）。共评估了113个（PET1）和48个（PET2）转移灶。结果显示，治疗后淋巴结转移灶的PSMA摄取（中位SUVmax）保持稳定（7.8 vs. 7.7，p = 0.77），而骨转移灶（6.4 vs. 12.4，p = 0.03）和肺转移灶（4.5 vs. 8.1，p = 0.004）的摄取显著增加。淋巴结中SUV的稳定性与肾细胞癌亚型无关（ccRCC：p = 0.48；pRCC：p > 0.99）。在ccRCC中，骨转移灶（6.6 vs. 15.9，p = 0.008）和肺转移灶（4.8 vs. 8.1，p = 0.02）的PSMA摄取更高，而pRCC中则未见此差异（骨转移：6.2 vs. 6.0，p = 0.86）。 结论：在mRCC患者开始全身治疗后，PSMA放射性配体摄取的变化见于骨和肺转移灶，但淋巴结转移灶中未见此变化。与其他肾细胞癌亚型相比，ccRCC具有更高的PSMA摄取。
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