Percutaneous hepatic perfusion versus best alternative care as treatment for metastatic uveal melanoma: A meta-analysis.

Evidence on the efficacy of percutaneous hepatic perfusion (PHP) in metastatic uveal melanoma (mUM) is largely derived from single-arm studies without comparators, complicating interpretation of treatment benefit, particularly for survival. This meta-analysis aimed to synthesize available evidence on the efficacy and safety of PHP in patients with mUM and compare outcomes with best alternative care (BAC). PubMed, Embase, Cochrane, and Web of Science were searched from database inception to Feb 17, 2026. Studies evaluating PHP in patients with mUM and BAC cohorts derived from randomized trials of PHP or isolated hepatic perfusion were included. The endpoints were 1-year overall survival (OS), 2-year OS, median OS (mOS), 1-year progression-free survival (PFS), median PFS (mPFS), overall response rate (ORR), and safety. Random-effects meta-analyses were performed using restricted maximum likelihood estimation. Eleven studies were included (one reporting on both PHP and BAC), comprising 455 patients treated with PHP (nine studies) and 125 treated with BAC (three studies). The pooled 1-year OS was 65.5% (95% CI 52.8-75.5%) for PHP and 64.3% (95% CI 13.3-90.7%) for BAC. The pooled 2-year OS was 35.4% (95% CI 28.5-42.4%) and 28.1% (95% CI 9.6-50.2%), and mOS 17.3 months (95% CI 11.8-22.8) and 14.0 months (95% CI 4.3-23.6), respectively. PHP was associated with higher ORR (47.4% vs 6.0%), longer 1-year PFS (30.1% vs 6.4%) and mPFS (7.7 vs 2.6 months). Hematologic adverse events were the most frequently reported toxicities in PHP studies. PHP is associated with improved ORR and PFS compared with BAC in patients with mUM, although no clear survival benefit was observed.