Background/Objectives: Melphalan-based percutaneous hepatic perfusion (M-PHP) became approved in 2023 for treatment of liver-dominant metastatic uveal melanoma (mUM). Patients with liver-dominant mUM have a poor overall survival (OS) ≤ 12 months; however, the reported OS benefit from M-PHP varies in clinical trials from 9.6 to 27.4 months and remains uncertain. Here, we report the OS outcome after 10 years’ experience with M-PHP treatment of patients with liver-dominant mUM. Methods: A total of 38 consecutive patients (19 women, median age 57.7 years) with liver-dominant mUM underwent 99 M-PHP procedures (median: 2.6 M-PHP/patient) between April 2014 and March 2024 at our institution. OS outcomes were retrospectively analyzed using Kaplan–Meier methods and Cox proportional hazard models. Results: Median OS was 29.1 months after first M-PHP treatment (median follow-up: 25.8 months). The estimated percentage of patients surviving at 1, 2, and 3 years was 79.5%, 53.2%, and 28.5%, respectively. Each additional M-PHP cycle was associated with about 40% reduction in the risk of death (hazard ratio = 0.414). Median OS was numerically improved by 8.4 months with ≥3 versus ≤2 cycles of M-PHP administered (29.8 versus 21.4 months,p= 0.058). No treatment-related deaths occurred. Conclusions: This study found a clinically meaningful OS benefit in M-PHP-treated patients with liver-dominant mUM, reaching nearly 2.5-year median OS with ≥3 M-PHP cycles administered. This finding supports the need to account for the institutional volume and experience with the M-PHP procedure in both clinical practice and research, and may provide an OS reference for estimating OS gains in the evolving therapeutic landscape for mUM patients.
背景/目的：基于美法仑的经皮肝灌注术（M-PHP）于2023年获准用于治疗肝优势型转移性葡萄膜黑色素瘤。肝优势型转移性葡萄膜黑色素瘤患者的总生存期通常较差（≤12个月），但临床试验中报道的M-PHP带来的总生存期获益存在差异（9.6至27.4个月），仍存在不确定性。本文报告了我们机构10年来采用M-PHP治疗肝优势型转移性葡萄膜黑色素瘤患者的总生存期结果。方法：2014年4月至2024年3月期间，共有38例连续收治的肝优势型转移性葡萄膜黑色素瘤患者（女性19例，中位年龄57.7岁）在我机构接受了99次M-PHP治疗（中位治疗次数：2.6次/患者）。采用Kaplan-Meier法和Cox比例风险模型对总生存期结果进行回顾性分析。结果：首次M-PHP治疗后中位总生存期为29.1个月（中位随访时间：25.8个月）。患者1年、2年和3年生存率估计值分别为79.5%、53.2%和28.5%。每增加一个M-PHP治疗周期，死亡风险降低约40%（风险比=0.414）。接受≥3个周期与≤2个周期M-PHP治疗的患者中位总生存期数值上提高8.4个月（29.8个月 vs 21.4个月，p=0.058）。治疗期间未发生治疗相关死亡。结论：本研究发现M-PHP治疗为肝优势型转移性葡萄膜黑色素瘤患者带来了具有临床意义的总生存期获益，接受≥3个M-PHP周期的患者中位总生存期接近2.5年。这一发现支持在临床实践和研究中需考虑机构的M-PHP手术量和经验，并可能为评估转移性葡萄膜黑色素瘤患者不断发展的治疗格局中的总生存期获益提供参考依据。
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