Knowledge-Graph Grounding Helps LLMs Only for Out-of-Training Knowledge: A Controlled Study on Clinical Question Answering

A graph retrieval-augmented generation pipeline chooses which triples to put in the prompt, a syntax to write them in, an order to write them in, and a sentence telling the model what to do with them. We vary all four over six large language models and two knowledge-graph question answering benchmarks. Two of the four choices move the answer and the other two are flat. The first is whether the answer path, the triples needed to reach the answer, is in the prompt at all. Holding the number of triples fixed and replacing every triple that is not on the chain with material from an unrelated entity changes answer accuracy by +0.003 F1, while removing the chain costs most of what the graph was worth. Retrieval budget belongs on recall, and precision in the range we can test buys nothing. There is no retriever here: subgraphs come from gold SPARQL, so precision describes the context we build, not a system setting. The second is the grounding instruction. With no facts in the prompt, telling a model to answer using only the provided facts drops F1 from 0.299 to 0.035, a factor of 8.63. That figure describes an evaluation with an empty context arm rather than a working pipeline, and an experiment that applies the instruction to its context arm but not to its no-context baseline manufactures a spurious finding that graph context hurts at depth. We found one in our own results and retract it. Syntax, triple order and subgraph size produce no effect we can measure at multi-hop depth. The comparison that would price the grounding instruction against correct context is not measurable with a format-sensitive scorer, because the instruction determines the response format; we report it as an open contrast rather than a number.

Retrieval of information from graph-structured knowledge bases represents a promising direction for improving the factuality of LLMs. While various solutions have been proposed, a comparison of methods is difficult due to the lack of challenging QA datasets with ground-truth targets for graph retrieval. We present SynthKGQA, an LLM-powered framework for generating high-quality Knowledge Graph Question Answering datasets from any Knowledge Graph, providing the full set of ground-truth facts in the KG to reason over questions. We show how, in addition to enabling more informative benchmarking of KG retrievers, the data produced with SynthKGQA also allows us to train better models.We apply SynthKGQA to Wikidata to generate GTSQA, a new dataset designed to test zero-shot generalization abilities of KG retrievers with respect to unseen graph structures and relation types, and benchmark popular solutions for KG-augmented LLMs on it.

Knowledge graphs (KGs) are increasingly used to support large lan guage model (LLM) reasoning, but standard triplet-based KGs treat each relation as globally valid. In many settings, whether a relation should count as evidence depends on the context. We therefore formulate triplet validity as a triplet-specific function of context and refer to this formulation as a Quantum Knowledge Graph (QKG). We instantiate QKG in medicine using a diabetes-centered PrimeKG subgraph, whose 68,651 context-sensitive relations are further annotated with patient-group-specific constraints. We evaluate it in a reasoner--validator pipeline for medical question answering on a KG-grounded subset of MedReason containing 2,788 questions. With Haiku-4.5 as both the Reasoner and the Validator, KG-backed validation significantly improves over a no-validator baseline ($+0.61$ pp), and QKG with context matching yields the largest gain, outperforming both KG validation without context matching ($+0.79$ pp) and the no-validator baseline ($+1.40$ pp; paired McNemar, all $p<0.05$). Under a stronger validator (Qwen-3.6-Plus), the raw QKG gain over the no-validator baseline grows from $+1.40$ pp to $+5.96$ pp; the context-matching gap is non-significant ($p=0.73$) on the raw set but becomes borderline significant ($p=0.05$) after adjustment for knowledge leakage and suspicious questions, consistent with a benchmark-gold ceiling rather than a QKG limitation. Taken together, the results support the view that the value of a KG in LLM-based clinical reasoning lies not merely in storing medically related facts, but in representing whether those facts are applicable to the specific patient context. For reproducibility and further research, we release the curated QKG datasets and source code.\footnote{https://github.com/HKAI-Sci/QKG}