葡萄膜黑色素瘤常转移至肝脏，预示着预后不良。通过经皮肝灌注 (PHP) 的马法兰/肝脏输送系统 (HDS) 是一种通过受影响的肝脏循环高剂量化疗的微创方法。本研究评估了马法兰/HDS 作为一线或二线治疗的使用，以指导治疗顺序。一项回顾性研究纳入了 2008 年至 2023 年通过 PHP 接受马法兰/HDS 治疗的肝优势转移性葡萄膜黑色素瘤患者。确定了 30 名患者； 53.3%为女性，中位年龄为63.5岁（37-78岁）。中位随访时间为 14.5 个月。一线疗法包括马法兰/HDS (n = 17)、肝脏定向疗法 (n = 7) 和免疫疗法 (n = 6)。二线治疗包括马法兰/HDS (n = 6)、免疫治疗 (n = 5) 和肝脏靶向治疗 (n = 3)。一线马法兰/HDS、免疫治疗和肝脏定向治疗的中位肝无进展生存期 (hPFS) 分别为 17.6/8.8/9.2 个月 (P = 0.002)。二线美法仑/HDS、免疫治疗和肝脏定向治疗的中位 hPFS 分别未达到/14.7/7.5 个月（P < 0.001）。一线马法兰/HDS、免疫治疗和肝脏定向治疗的中位总体 PFS 分别为 15.4/8.8/9.2 个月 (P = 0.04)。二线美法仑/HDS、免疫疗法和肝脏定向治疗的中位总 PFS 分别为 22.2/14.7/7.5 个月 (P = 0.001)。通过 PHP 进行美法仑/HDS 治疗转移性葡萄膜黑色素瘤至肝脏的疗效显着与免疫疗法或肝脏定向疗法相比，用作一线疗法时，hPFS 和总体 PFS 得到改善。与二线免疫疗法或肝脏定向疗法相比，PHP 用作二线疗法时，hPFS 和 PFS 继续得到改善。© 2024。外科肿瘤学会。

Uveal melanoma often metastasizes to the liver, portending a poor prognosis. Melphalan/hepatic delivery system (HDS) via percutaneous hepatic perfusion (PHP) is a minimally invasive means of circulating high-dose chemotherapy through the affected liver. This study evaluated melphalan/HDS use as either first-line or second-line treatment to guide treatment sequencing.A retrospective review included patients with hepatic-dominant metastatic uveal melanoma who underwent melphalan/HDS treatment via PHP from 2008 to 2023.A total of 30 patients were identified; 53.3% female, with a median age of 63.5 years (37-78 years). Median follow-up time was 14.5 months. First-line therapies included melphalan/HDS (n = 17), liver-directed (n = 7), and immunotherapy (n = 6). Second-line therapies included melphalan/HDS (n = 6), immunotherapy (n = 5), and liver-directed (n = 3). Median hepatic progression-free survival (hPFS) for first-line melphalan/HDS, immunotherapy, and liver-directed therapy was 17.6/8.8/9.2 months, respectively (P = 0.002). Median hPFS for second-line melphalan/HDS, immunotherapy, and liver-directed therapy was not reached/14.7/7.5 months, respectively (P < 0.001). Median overall PFS for first-line melphalan/HDS, immunotherapy, and liver-directed therapy was 15.4/8.8/9.2 months, respectively (P = 0.04). Median overall PFS for second-line melphalan/HDS, immunotherapy, and liver-directed therapy was 22.2/14.7/7.5 months, respectively (P = 0.001).Melphalan/HDS via PHP for metastatic uveal melanoma to the liver was found to have significantly improved hPFS and overall PFS when used as first-line therapy compared with immunotherapy or liver-directed therapy. PHP continued to demonstrate improved hPFS and PFS when used as second-line therapy compared with second-line immunotherapy or liver-directed therapy.© 2024. Society of Surgical Oncology.