Cancer Survival Prediction

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3 papers in the last four weeks, with none the four weeks before. 0.0% of all new papers.

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Latest papers 51

Oct 6, 2026cs.CV

Anchor-driven Multi-modal Multi-scale Expert Selection for Survival Prediction

The integrative analysis of histopathological Whole-Slide Images (WSIs) and transcriptomic profiles holds significant promise for cancer survival prediction. However, existing methods typically project multi-modal features directly into a shared latent space without explicit alignment, leading to the entanglement of mismatched morphological cues and molecular signals. Furthermore, current fusion strategies often treat the extreme spatial heterogeneity of WSIs uniformly, lacking mechanisms to adaptively prioritize clinically relevant tissue scales for individual patients. To address these limitations, we propose an Anchor-driven Multi-modal Multi-scale Expert Selection (AM

^2

ES) framework for survival prediction. Specifically, we present an Anchor-driven Multi-modal Fusion (AMF) module, which introduces learnable semantic anchors as cross-modal mediators to bridge the semantic gap by enforcing a structurally regularized alignment between transcriptomic features and multi-scale pathology representations. Built upon this aligned semantic space, we further design a Hierarchical Mixture-of-Experts (H-MoE) selection module to decouple the hierarchical prognostic selection process. Mimicking the pathologist's diagnostic workflow, H-MoE performs (i) Intra-scale Expert Filtering to discriminatively identify salient tumor regions within each magnification, and (ii) Inter-scale Hierarchy Routing to dynamically weight and select the most informative resolution levels. Extensive experiments on multiple TCGA cancer cohorts demonstrate that our AM

^2

ES achieves state-of-the-art performance while offering fine-grained interpretability by visualizing how specific molecular pathways drive the expert routing decisions across tissue scales. The code will be released at https://github.com/taozh2017/AM2ES.

Tao Zhou, Ying Hu, Huazhu Fu +3

School of Computer Science and Engineering, Nanjing University of Science and Technology, Nanjing 210094, China · Institute of Advanced Intelligence and Computing (IAIC), Agency for Science, Technology and Research (A*STAR), Singapore 138632 · School of Computer Science and Engineering, Southeast University, Nanjing 211189, China +2

Cancer Survival Prediction Mixture of Experts Multi-Scale Feature Fusion Multimodal Survival Analysis Multimodal Fusion Whole-Slide Image Analysis

Sep 28, 2026cs.CV

Modeling Whole-Slide Images as Dynamic Tumor Microenvironment Fields

Due to the gigapixel-scale nature of whole-slide images (WSIs), weakly supervised WSI analysis is commonly formulated as a multiple instance learning (MIL) problem, where patch-level features are aggregated into slide-level representations. However, diagnostic and prognostic evidence often arises from spatially coherent tumor microenvironment regions and their interactions, rather than isolated patches alone. Existing patch-level or static region-based methods usually overlook how tissue regions should be adaptively formed and subsequently evolved through microenvironment interactions across heterogeneous boundaries. In this paper, we propose Concept-Guided Tumor Microenvironment Evolution (TMEvolve), a reaction-diffusion-inspired framework that models WSIs as latent tumor microenvironment fields over discrete patch graphs. TMEvolve instantiates this view as a learnable graph-discretized evolution process over patch neighborhoods. It first forms adaptive soft tissue regions as coherent microenvironment units, then performs pseudo-time evolution through two complementary local dynamics: intra-region diffusion, which stabilizes latent states within coherent tissue compartments, and concept-guided boundary flux, which propagates visual feature signals and language-derived concept signals across heterogeneous region interfaces. The evolved microenvironment regions are finally aggregated for slide-level prediction. We evaluate TMEvolve on six datasets across three weakly supervised WSI tasks: survival prediction, gene expression prediction, and histological subtype classification. TMEvolve consistently improves over representative MIL methods, pathology foundation models, and concept-guided baselines. Ablation studies and visualizations further support the effectiveness and interpretability of TMEvolve, highlighting the value of dynamic region modeling and boundary interaction.

Lei Wu, Jiashuai Liu, Di Zhang +9

School of Computer Science and Technology, Xi’an Jiaotong University · University of Cambridge · Institute of Intelligent Medicine, Chinese Academy of Medical Sciences

Cancer Survival Prediction Histopathology Image Classification Multiple Instance Learning Whole-Slide Image Analysis

Sep 24, 2026cs.CV

A Multimodal Dataset for Survival Prediction in Resected Pancreatic Ductal Adenocarcinoma

Survival research in pancreatic ductal adenocarcinoma (PDAC) is limited by the scarcity of datasets linking whole-slide histology with clinical, molecular, and long-term outcome data. We present a retrospective single-centre cohort of 302 patients who underwent PDAC resection at University Medical Center Gottingen. The dataset comprises 446 H&E whole-slide images, clinicopathological variables, targeted sequencing data for 154 patients, and overall-survival outcomes. During follow-up, 253 patients died, and the median follow-up was 76 months. To establish initial reference values, we evaluated fourteen survival-prediction configurations using identical five-repetition Monte Carlo cross-validation partitions. Ridge Cox regression using numeric clinicopathological variables achieved a mean concordance of

0.649 \pm 0.042

and

0.652 \pm 0.046

after adding KRAS and TP53 mutation status. The image-only attention model achieved

0.603 \pm 0.030

, while multimodal fusion achieved

0.619 \pm 0.025

, the highest concordance among the neural models. These results establish promising initial benchmarks for future research using this pancreas-specific multimodal dataset, paving the way for external validation.

Anh-Tien Nguyen, Mawuko Tettey, Jacqueline Michelle Metsch +14

Institute for Predictive Deep Learning for Medicine and Healthcare, Giessen University, Germany · Department of Medical Informatics, University Medical Center Göttingen, Germany · Institute of Pathology, University Medical Center Göttingen, Germany +2

Cancer Survival Prediction Oncology Multimodal Survival Analysis Whole-Slide Image Analysis Multimodal Learning

Sep 8, 2026eess.IV

CHIMERA Challenge Task 2 and 3: Response Subtypes Classification and Progression Survival Prediction in Bladder Cancer Patients using Multimodal Datasets

High-risk non-muscle-invasive bladder cancer (HR-NMIBC) carries substantial risks of recurrence and progression, while current clinical risk stratification remains limited. CHIMERA was established as a multimodal AI challenge to benchmark prediction in HR-NMIBC under standardized evaluation. Task BRS predicts RNA-seq-defined BCG Response Subtypes from histopathology and structured clinicopathological data, whereas Task Progression models time-to-progression using histopathology, structured data, and RNA sequencing. A multimodal dataset of 368 patients was divided into public training and hidden validation and test sets. In total, 159 submissions were made, and 13 top-performing models were selected for benchmarking. The best models achieved a weighted F1 score of 0.73 for Task BRS and a C-index of 0.68 for Task Progression. Post-challenge analyses revealed task-dependent modality contributions, cohort-dependent performance degradation, and sensitivity to missing structured data. In Task BRS, histopathology partly compensated for pathology-derived structured variables, whereas progression models showed greater dependence on complementary inputs. Cross-model error analysis further identified patients that were consistently difficult across different architectures, with T1 substage associated with prediction difficulty. These findings highlight barriers to transportability and the importance of missingness-aware modeling and independent multi-institutional validation. CHIMERA provides a standardized multimodal benchmark for bladder cancer and a framework for studying not only model performance, but also robustness, information sufficiency, and patient-level prediction failure.

Catherine Chia, Tongjie Wang, Robert Spaans +12

Multimodal Robustness Cancer Survival Prediction Oncology Multimodal Survival Analysis Multimodal Model Evaluation

Aug 8, 2026cs.CV

Gated Spatial Redundancy Projection for Pathology Transformer Attentions

Transformer models are increasingly used for whole-slide image analysis in computational pathology. Yet, WSIs differ fundamentally from natural images: neighbouring patches often contain highly similar tissue type, stain, texture, and cellular composition. We identify this local spatial redundancy as a pathology-specific failure mode of self-attention, where dominant neighbourhood features can be repeatedly mixed into patch-tokens and weaken subtle diagnostic or prognostic deviations. We propose Gated Spatial Redundancy Projection (Gated SRP), a lightweight drop-in correction module for self-attention layers. For each patch token and attention head, Gated SRP estimates a local redundancy axis from neighbouring value vectors, projects the attention output onto this axis, and applies a learned signed gate to correct the redundancy-aligned component geometrically. Across five TCGA survival cohorts, Gated SRP obtains the highest mean C-index among the compared attention variants in all cohorts, with an average improvement over the base attention, while adding only +0.02% parameters. Across five slide-level classification datasets, it improves the base attention on 12 of 16 reported metrics and achieves the best AUC on three datasets. Code is publicly available at https://github.com/AtlasAnalyticsLab/GatedSRP.

Zhiyuan Yang, Jiahao Cheng, Vincent Quoc-Huy Trinh +1

Department of Computer Science and Software Engineering (CSSE), Concordia University, Montreal, Canada · Axe Cancer, Centre de recherche du CHUM, Université de Montréal, Montréal, Canada · Mila - Quebec AI Institute, Montreal, Canada

Cancer Survival Prediction Self-Attention Attention Mechanisms Histopathology Image Classification Whole-Slide Image Analysis

Aug 8, 2026cs.LG

DoGMA: A Central-Dogma-Guided Foundation Model for Multi-Omics Alignment and Multi-Task Learning in Oncology

Attention mechanisms have been widely utilized in modern deep learning, and many existing multi-omics models inherit their conventional use to allow unrestricted bidirectional interactions. However, the fundamental logic of life is directional. Existing designs often overlook the directionality suggested by the central dogma, potentially limiting transfer across heterogeneous cancers, downstream tasks, and incomplete modality settings. In this work, we present DoGMA, a central-dogma-guided foundation model for pan-cancer multi-omics analysis, arguing that robust transfer requires representations with domain-specific inductive bias. Concretely, we build it on a Transformer-MoE architecture where directed attention biases inter-omics communication toward central-dogma information flow. We further pretrain our model with masked hierarchical omics reconstruction to guide it toward learning central-dogma-consistent interactions. Across diverse downstream tasks, including cancer representation learning, survival prediction, and metastasis prediction, DoGMA consistently demonstrates strong predictive performance. Ablations and analyses further suggest that the performance gains arise from the synergy between central-dogma-guided directed attention and reconstruction-based pretraining, which together promote more biologically consistent cross-omics information exchange. Overall, DoGMA demonstrates that domain-specific inductive biases can improve the robustness and transferability of multi-omics foundation models, offering new insights into the design of attention mechanisms for multi-omics representation learning.

Junfei Ling, Bangzheng Pu, Bingsen Xue +3

Institute of Medical Robotics, Shanghai Jiao Tong University · Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai 200240, China · Institute of Data Science, The University of Hong Kong +1

Cancer Survival Prediction Clinical Outcome Prediction Oncology Attention Mechanisms Molecular Representation Learning

Aug 4, 2026cs.CV

CIGTSurv: Clinical Information Guided Tri-modal Survival Prediction with Local Prototype Association and Global Feature Alignment

Multimodal learning has significantly advanced survival prediction by integrating pathology images with genomic data. However, clinical information, despite its critical role in reflecting a patient' s overall health, remains underutilized due to its discrete, sparse, and low-dimensional nature. Furthermore, the inherent heterogeneity across these modalities pose significant challenges in modeling cross-modal interactions. In this paper, we propose CIGTSurv, a Clinical Information Guided Tri-modal framework for Survival prediction. Specifically, we first design a holistic text template and use pretrained foundation models to transform clinical tabular data into high-dimensional tokenized embeddings. Using clinical information as an anchor, we then introduce a dual-level interaction mechanism: 1) a local prototype association (LPA) module based on cross-attention to explicitly learn token-level correspondences between different modalities, and 2) a global feature alignment (GFA) loss based on Maximum Mean Discrepancy (MMD) to implicitly enhance cross-modal distribution consistency. Extensive experiments on five TCGA cancer cohorts demonstrate that CIGTSurv achieves state-of-the-art (SOTA) survival prediction performance. Our source code is publicly available at https://github.com/Daijing-ai/CIGT-Surv.git.

Jing Dai, Qibin Zhang, Weiwei Zhou +4

Cancer Hospital of Dalian University of Technology, Shenyang, China · School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian, China · Institute of Pathology, Technical University of Munich, TUM School of Medicine and Health, Munich, Germany +2

Cancer Survival Prediction Survival Analysis Cross-Modal Alignment Oncology Multimodal Survival Analysis Multimodal Fusion

Aug 4, 2026q-bio.QM

The Cost of Binarizing Survival Outcomes in Clinical Prognostic Modeling

Survival analysis is an established framework for analyzing time-to-event data, yet many clinical machine learning studies still binarize the outcome before model training. This practice excludes censored patients, collapses temporal information into a single threshold, and can affect which features are selected as prognostically relevant. We examine the cost of this binarization in the context of Bayesian network (BN) feature selection, using two recent publications as case studies: one that applies BN-based feature selection to a head-and-neck cancer cohort and a second surgical cohort study that, while not BN-based, likewise binarizes its survival endpoint. We replace the binary scoring function with the Cox partial log-likelihood for feature-to-outcome edges, a modification we call the Survival-Aware Bayesian network, and recover prognostic features that binarization misses. Our ablation experiment confirms that the improvement is driven by the time-to-event scoring formulation rather than by retaining more patients. The results generalize across five endpoint-cohort combinations in head-and-neck cancer and extend to three further cancer types (breast, colorectal, and kidney). We propose that clinical studies with survival outcomes should use time-to-event methods by default, as binarization discards the prognostic signal retained by survival analysis.

Shashank Yadav, David M. Routman, Andrew Y. K. Foong

Department of Radiation Oncology Mayo Clinic, Rochester, MN, USA 55905

Cancer Survival Prediction Bayesian Networks Survival Analysis

Aug 4, 2026cs.AI

Spatial proteomics guided by H&E-based AI reveals recurrence-risk niches in triple-negative breast cancer

Deep learning models can predict cancer recurrence from H&E stained slides, but the localized molecular states underlying these predictions remain largely obscured. Here, we developed an outcome informed spatial pathology framework in TNBC that integrates AI generated recurrence risk heatmaps with mass spectrometry based spatial proteomics. In a cohort of 156 patients, distribution based aggregation of high scoring patches achieved an AUC of 0.77 and a C-index of 0.77 in an independent test cohort. Bulk proteomics associated high image derived risk with cell cycle and genome maintenance programs and low risk with immune activation. High and low risk patches coexisted within the same tumor compartment and displayed distinct nuclear and architectural features, revealing intratumoral heterogeneity beyond tissue compartment identity. We then used the heatmaps as coordinate level guides to physically isolate and profile 46 AI defined tumor regions from two recurrence patients. Spatial proteomic profiling revealed a concordant molecular contrast across both patients: mitotic programs were enriched in high risk regions and immune and antigen presentation programs in low risk regions. A 13 protein composite derived from these spatial contrasts showed a trend toward poorer recurrence-free survival with increasing scores in an expanded cohort, while the corresponding transcript based composite stratified recurrence free survival in the independent METABRIC TNBC cohort. Integrating the protein composite with the H&E derived risk score improved the out of bag C-index from 0.679 to 0.739 and enhanced time dependent discrimination at 3 and 5 years. Together, these findings define a new role for outcome trained AI models as spatially explicit experimental guides that connect prognostic morphology with localized molecular states and advance biologically grounded, multiscale biomarker discovery in TNBC.

Yesung Cho, Ji Hwan Park, Chanil Kim +27

OmixAI Co. Ltd., Seoul, Republic of Korea · Meteor Biotech Co. Ltd., Seoul, Republic of Korea · Oncocross Co. Ltd., Seoul, Republic of Korea +4

Breast Cancer Computational Pathology Cancer Survival Prediction Clinical Outcome Prediction Oncology Whole-Slide Image Analysis

Aug 3, 2026cs.CV

SAGE: Semantic Explainability of Attention-Based Survival Models in Computational Pathology

Attention-based multiple instance learning (ABMIL) is the predominant approach for slide-level prediction in computational pathology, yet its attention maps provide only local explanations: they indicate where a model focuses but not which histological features drive its predictions or how the model behaves across a patient cohort. We present Semantic Attention Global Explanations (SAGE), a post-hoc framework that extracts global, language-grounded explanations from a frozen ABMIL model. Using a pathology vision-language model, SAGE scores image patches against a dictionary of 25 histological concepts, aggregates these scores according to the model's learned attention, and quantifies how each concept relates to prediction risk across a cohort. Applied to survival prediction using seven TCGA cancer cohorts and three foundation models, SAGE recovered established prognostic features, such as the adverse association of necrosis, while revealing cancer-specific biology, including a favorable angiogenic signature in renal cell carcinoma consistent with known molecular subtypes. Ablation studies demonstrated that these associations depend on the model's learned attention rather than concept prevalence alone, and that the concept dictionary captures much of the prognostic information encoded by the foundation model features. Through semantically-grounded explanations, SAGE provides a scalable, model-agnostic framework for understanding what ABMIL survival models learn, enabling pathologists to interpret model behavior at the cohort level and offering the potential for biomarker identification.

Abdallah Lamane, Abdul Rahman Diab, Ren-Chin Wu +1

Massachusetts Institute of Technology, Cambridge, MA, USA · Department of Data Science, Dana-Farber Cancer Institute, Boston, MA · Department of Pathology, Dana-Farber Cancer Institute, Boston, MA +2

Computational Pathology Cancer Survival Prediction Concept-Based Explanations Oncology Explainable Medical Image Analysis Multiple Instance Learning

Aug 1, 2026cs.CV

Structured Proxy Features for Multimodal NSCLC Survival Prediction from Pretreatment CT

Lung cancer results in roughly 1.8 million fatalities annually worldwide, with non-small cell lung cancer (NSCLC) comprising the majority of cases. Despite advancements in treatment, survival stratification remains challenging due to intratumoral heterogeneity inadequately captured by conventional descriptors. Standard radiomic and deep learning techniques regard imaging features as independent quantities, overlooking structured interactions between tumor characteristics. We evaluate whether structured proxy features can enhance multimodal NSCLC survival prediction by augmenting pretreatment computed tomography (CT) representations, radiomics, and clinical variables with six simulation-derived features designed to capture interactions between heterogeneity and morphology. A radiomic-parameterized cellular automaton generates growth-rate and necrosis-ratio proxy features from baseline CT by using entropy and sphericity to compute low-dimensional proxy parameters. The imaging backbone is a Transformer-based Masked Autoencoder (TMAE), which was chosen after a systematic evaluation with alternative encoders within the same pipeline and provides attention-based visualizations that highlight tumor regions receiving higher model attention. On the public Lung1 cohort (n = 390), the primary four-modality fusion attained a C-index of 0.641 (iAUC 0.731, log-rank p < 0.001). The primary result compares favorably with prior multimodal results on Lung1 (C-index 0.631; iAUC 0.592 [15]) under a comparable evaluation protocol, while a separate exploratory coefficient-optimization analysis achieved a best observed C-index of 0.662 (iAUC 0.748). These results indicate that, in addition to conventional radiomic, deep, and clinical representations within the Lung1 benchmark, simulation-derived proxy features may provide complementary predictive information within this fixed Lung1 benchmark.

Huu Phong Nguyen, Delower Hossain, Ehsan Saghapour +2

Department of Biomedical Informatics and Data Science, School of Medicine, The University of Alabama at Birmingham (UAB), Birmingham, AL, United States. · Department of Computer Science, The University of Alabama at Birmingham (UAB), Birmingham, AL, United States. · System Pharmacology and AI Research Center (SPARC), The University of Alabama at Birmingham (UAB), Birmingham, AL, United States.

Cancer Survival Prediction Oncology Multimodal Survival Analysis Radiomics Multimodal Fusion

Jul 29, 2026cs.CV

Empirical investigation of 3D CT Foundation Models and Unsupervised Adaptation for Head and Neck Cancer Recurrence Prediction

The rapid emergence of 3D CT foundation models has opened new avenues for predictive modeling from CT imaging, offering a compelling alternative to traditional radiomics which is known to suffer from reproducibility issues and sensitivity to acquisition protocol variations. Yet, as these models grow in availability, a critical need arises to evaluate how well their learned representations generalize across diverse clinical settings and whether adaptation to specific downstream tasks is necessary to unlock their full potential. To address these questions, we benchmarked several 3D CT foundation models for predicting recurrence-free survival in head and neck cancer across two public datasets totaling 3,644 patients, evaluating various adaptation strategies and modality fusion mechanisms. Our findings reveal persistent difficulty in identifying features that generalize consistently across different imaging distributions, as evidenced by significant performance drops on external validation cohorts. Ultimately, the integration of imaging features with clinical data remains the most accurate approach for prognostic prediction, though achieving universal generalization across varied clinical contexts continues to represent a substantial challenge for the current generation of models.

Bilel Guetarni, Feryal Windal, David Pasquier +1

University of Lille, CRISTAL UMR CNRS 9189, France · Junia, Lille, France · UMR 8520, CNRS, France +4

Medical Imaging Foundation Models Unsupervised Domain Adaptation Cancer Survival Prediction Clinical Outcome Prediction Computed Tomography Cross-Dataset Generalization

Jul 29, 2026cs.CV

HERMES: A Hybrid Ensemble for Head-and-Neck Tumor Segmentation, TN Staging, and Recurrence-Free Survival on PET/CT

We present HERMES (Hybrid Ensemble for Radiotherapy-target segmentation, Malignancy staging, and Event-free Survival), a single containerized algorithm for the three HECKTOR 2026 subtasks: segmentation of the primary tumor (GTVp) and pathological lymph nodes (GTVn), radiological T/N staging, and recurrence-free survival (RFS), computed from a paired FDG-PET/CT scan and an electronic health record. A 10-fold ensemble of STU-Net Small networks produces the segmentation; the predicted mask then drives two downstream tasks. Rather than pass a generic radiomics vector to the staging models, we derive from the predicted masks a compact set of geometry features aligned with the size and number axes of AJCC/UICC 7th-edition radiological N/T staging. On internal cross-validation these features raise N-stage balanced accuracy from 0.691 to 0.720 (+0.030), our largest single design gain, at lower feature dimensionality. For prognosis we combine complementary deep and clinical risk experts in an equal-weight ensemble, and train one deep expert with a concordance-tracking survival loss of our own, whose value approximates the concordance index during training. Every component was selected on honest out-of-fold predictions under a regularization-oriented protocol, with no tuning on the public validation set, and deployed as two decorrelated submissions. On the HECKTOR 2026 validation leaderboard, HERMES achieved a weighted score of 0.6454 (Mean Dice 0.641, T balanced accuracy 0.580, N balanced accuracy 0.642, RFS C-index 0.679) and qualified for the testing phase. Team: AMC_HNC.

Kai Wang, Meixu Chen, Elie Nasr +2

Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA

Cancer Survival Prediction PET/CT Imaging Medical Image Segmentation Oncology PET/CT Tumor Segmentation

Jul 26, 2026eess.IV

Segmentation Robustness and Predictive Utility in Glioblastoma Radiomics: Evidence for a Trade-off in Survival Modelling

Radiomic biomarkers derived from magnetic resonance imaging (MRI) have been widely investigated as non-invasive tools for tumor characterization and prognostic modeling in glioblastoma (GBM). However, their clinical translation remains limited, in part due to sensitivity to tumor segmentation variability. In this study, we systematically investigate the relationship between feature robustness and predictive utility in GBM survival modeling using the University of Pennsylvania Glioblastoma Imaging, Genomics, and Radiomics (UPENN-GBM) cohort. A total of 4,752 radiomic features were obtained from multiparametric MRI across three tumor subregions: enhancing tumor (ET), peritumoral edema (ED), and necrotic core (NC). Feature robustness was quantified using the intraclass correlation coefficient (ICC) based on the automatic and expert-refined segmentation versions. Among features with valid ICC estimates, 48.1% were classified as robust. Survival prediction was evaluated using cross-validation with Coxnet, Random Survival Forest, and Gradient Boosting Survival Analysis models. In this cohort, radiomic feature inclusion showed no consistent improvement over the clinical baseline, and robustness filtering produced no detectable performance gain. Model-selected features were less robust than the overall feature pool, indicating a lack of enrichment for robustness. These findings suggest that robustness alone is not a reliable criterion for feature selection in radiomics-based survival modelling.

Mariya Miteva, Maria Nisheva-Pavlova

Faculty of Mathematics and Informatics – Sofia University St. Kliment Ohridski, 5 James Bourchier Blvd., Sofia 1164, Bulgaria

Cancer Survival Prediction Radiomics

Jul 23, 2026stat.ME

A Multi-Cohort Validation of Censoring-Aware Conformal Lower Predictive Bounds for Pathology Survival Models

Whole-slide survival models commonly provide risk rankings without calibrated statements about individual event times. We evaluate fixed-cutoff drcosarc, a post-hoc conformal wrapper for discrete-time multiple-instance learning survival heads using frozen UNI2-h representations, in an internal 18-configuration sweep across five TCGA cohorts and an external five-configuration evaluation across three CPTAC cohorts. We distinguish configuration--fold--split summaries of the inverse-probability-of-censoring-weighted (IPCW) estimate and median lower predictive bound (LPB) from a hierarchy-aware patient-ensemble estimand of the mean drcosarc--naive LPB difference. At

α=0.1

, the drcosarc IPCW estimate was nearest 0.90 in KIRC, LUAD, and STAD. Patient-ensemble drcosarc--naive intervals excluded zero in KIRC, KIRP, STAD, UCEC, and CPTAC-CCRCC, but included zero in internal LUAD, CPTAC-LUAD, CPTAC-UCEC, and the internal LUSC extension. In a 20-replicate low-censoring semi-synthetic setting with known event times, drcosarc empirical coverage was 0.9129 [0.9053, 0.9207]. An exploratory analysis supported a head-error-by-censoring interaction within that data-generating process. In a two-cohort ABMIL sensitivity analysis, increasing the hazard grid to

K=16

raised localized marginal IPCW estimates above the prespecified 0.87 threshold and yielded positive paired LPB differences, although worst-group estimates remained below 0.87. Overall, performance was cohort dependent, and its interpretation changed with the patient-level unit, estimand, and censoring assumptions.

Mingi Hong

Independent Researcher

Computational Pathology Cancer Survival Prediction Survival Analysis Conformal Prediction Oncology Regression Prediction Intervals

Jul 10, 2026cs.AI

SAGEAgent: A Self-Evolving Agent for Cost-Aware Modality Acquisition in Multimodal Survival Prediction

Does every cancer patient truly need a complete diagnostic workup for accurate survival prediction? In multimodal clinical oncology, diagnostic modalities follow a clinically mandated order of escalating burden -- from demographics collected at intake to genomic profiling requiring specialized tissue analysis. Current multimodal survival methods either assume all modalities are available or passively handle missing data, but none actively reason about whether acquiring the next modality is justified for a given patient along this ordered workflow. We formulate this as a sequential decision problem and propose SAGEAgent (Sequential Acquisition Guided by Experience), a self-evolving LLM-based clinical agent that decides which diagnostic modalities to acquire for each patient, balancing predictive accuracy against clinical invasiveness. SAGEAgent reasons about each patient's evolving diagnostic state through clinical tools that translate numerical predictions into text, an episodic memory that retrieves similar past cases, and a semantic memory that accumulates reusable decision patterns from experience. Experiments on a glioma cohort combining TCGA-LGG, TCGA-GBM, and BraTS with four diagnostic modalities demonstrate that SAGEAgent achieves competitive survival prediction accuracy while reducing average acquisition burden by 55%.

Chongyu Qu, Can Cui, Zhengyi Lu +8

Vanderbilt University, Nashville TN 37235, USA · Vanderbilt University Medical Center, Nashville TN, 37232 USA

Cancer Survival Prediction Clinical Decision Support LLM Agent Self-Improvement Oncology Multimodal Survival Analysis Multimodal Agents

Jul 9, 2026cs.AI

Towards Precision Therapy in Hepatocellular Carcinoma: A Clinical-Reasoning LLM for Risk Stratification and Treatment Guidance

Hepatocellular carcinoma (HCC) is a common malignancy and a leading cause of cancer-related mortality. Current guidelines and staging systems provide coarse categories, but often miss within-stage heterogeneity and the clinical context in electronic medical records (EMRs). We present HCC-STAR (Hepatocellular Carcinoma Staging, Treatment And pRognosis), a clinically aligned large language model that reads routine EMR narratives and jointly outputs risk score-based staging, ranked guideline-consistent treatments with evidence-based rationales, and individualized survival estimates. We curated about 30,000 HCC cases from SEER and expanded them into EMR-style narrative training data using a clinician-validated, prompt-based augmentation workflow. On this corpus, we developed a knowledge-aligned reasoning framework optimized with a step-verifiable composite reward, moving beyond text-level memorization of clinical guidelines. In a multi-center cohort of 6,668 patients from 12 hospitals in China, HCC-STAR achieved state-of-the-art performance in treatment recommendation and risk stratification compared with clinical guidelines and competitive models, including GPT-5 and Gemini-2.5 Pro. Hypothetical overall-survival analysis showed a median survival of 51 months under adherence to HCC-STAR recommendations, compared with 29 and 32 months under BCLC and CNLC. In clinician-centric evaluations, blinded hepatobiliary specialists rated HCC-STAR's reasoning and evidence-based justifications as trustworthy. The model surpassed resident and attending physicians in treatment accuracy and helped physicians make more accurate decisions faster when used as an assistant. These findings support HCC-STAR as a reliable and verifiable decision-support system for risk stratification and precision therapy in HCC.

Peng Cui, Jitao Wang, Siyan Xue +41

Cancer Survival Prediction Clinical Decision Support Clinical Reasoning Oncology Medical LLMs Clinical Risk Prediction

Jul 9, 2026cs.CV

CT-CLIP Representations for Multimodal Lung Cancer Survival Prediction

Accurate prognosis prediction is important for treatment planning in lung cancer, but deep learning-driven survival modelling is often limited by the scarcity of curated imaging cohorts with reliable outcome data. This study evaluates whether representations from a domain-specific foundation model can be used for multimodal survival prediction in data-constrained clinical settings. We assess the foundation model CT-CLIP as a feature extractor for pretreatment computed tomography images and clinical variables from 242 diagnosed lung cancer patients. The evaluation includes adaptation strategies based on frozen encoders, full fine-tuning, and low-rank adaptation, together with modality ablations and comparisons with clinical and multimodal baselines. The results show that a frozen CT-CLIP model combined with a trainable lightweight survival head outperforms the clinical baseline and achieves comparable or improved performance relative to other multimodal approaches, and separates patients into clinically meaningful high- and low-risk groups.

Sofie Allgöwer, Mikael Johansson, Andreas Hallqvist +4

Chalmers University of Technology, Gothenburg, Sweden · Umeå University, Umeå, Sweden · Sahlgrenska University Hospital, Gothenburg, Sweden +1

Medical Imaging Foundation Models Radiology VLMs Cancer Survival Prediction Survival Analysis Oncology Multimodal Survival Analysis

Jul 6, 2026cs.LG

Biologically Informed Deep Neural Networks for Multi-Omic Integration, Pathway Activity Inference and Risk Stratification in Cancer

Integrating complex, multi-omics data presents significant challenges. Existing approaches often face a trade-off between model interpretability and representational capacity, with most either relying on post-hoc interpretation or use linear models that may overlook complex interactions. We report Pathway Activity Autoencoders for the multi-omics setting, which embed prior knowledge via pathway-informed architectural constraints, fostering interpretability, while preserving representational power. Our multi-omic framework is applied in the context of breast cancer and is evaluated in survival prediction and subtype classification with results indicating a positive effect of integration. We conduct analysis of individual omics layer impact on end-task performance, revealing that gene, protein, and microRNA expression layers provide the strongest contribution. Repeatability studies indicate that, while dropout improves model robustness and consistency, excessive regularisation can reduce predictive performance. Finally, visualizations of the learned feature space illustrate the framework's intrinsic transparency and clinical relevance. The results underscore the value of multi-omic integration and delineate the impact of individual omics layers, establishing practical guidelines for integration within our framework. Overall, our pathway activity autoencoder frameworks yield superior latent representations that are biologically meaningful and are directly translatable into clinically relevant insights.

Pedro Henrique da Costa Avelar, Le Ou-Yang, Min Wu +1

Department of Informatics, King’s College London, London WC2B 4BG, United Kingdom · Institute for Infocomm Research, Agency for Science, Technology and Research (A*STAR), Singapore 138632, Singapore · Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester +1

Cancer Survival Prediction Autoencoders Oncology

Jul 6, 2026cs.CV

MergeSurv: Merging-Based Continual Learning for Survival Analysis on Whole-Slide Images

Survival analysis on Whole Slide Images (WSIs) is important in computational pathology for prognosis estimation and treatment planning. However, existing survival models are typically trained independently for each cancer cohort, making continual adaptation computationally expensive for gigapixel-scale WSIs. In this study, we propose MergeSurv, a merging-based continual learning framework for WSI survival analysis. A pathology vision-language foundation model is independently fine-tuned on each task, and the learned parameters are sequentially merged into a unified model without storing previous training data. We further investigate two inference strategies: One-for-All (OFA) and Voting-Expert Aggregation (VEA). Experiments on four TCGA cohorts demonstrate that MergeSurv outperforms naive fine-tuning as well as representative regularization-based and rehearsal-based continual learning methods, while effectively reducing catastrophic forgetting. The results suggest that model merging is a promising direction for scalable and privacy-preserving continual learning in computational pathology.

Vu Minh Tran, Doanh C. Bui, Maï K. Nguyen +1

University of Information Technology · 2Viet Nam National University Ho Chi Minh City · 3ETIS (UMR 8051), CY Cergy Paris University, ENSEA, CNRS, France

Cancer Survival Prediction Survival Analysis Continual Learning Oncology Model Merging Whole-Slide Image Analysis

Jul 4, 2026cs.LG

SHIFT: Survival Prediction from Incomplete and Heterogeneous Genomic Data

Genomic prediction models often fail to transfer across institutions because sequencing panels differ across sites, creating structural feature missingness at deployment. Existing approaches to this challenge typically restrict analysis to genes shared across cohorts, exclude patients with incomplete profiles, or rely on test-time imputation, all of which can reduce robustness and limit the use of multi-center data. We propose Survival prediction Handling Incomplete Features using Transformer (SHIFT), a missingness-aware survival model that directly predicts from incomplete genomic inputs without test-time imputation. SHIFT represents each genomic feature separately and uses masked self-attention, along with a feature-availability mask, so that predictions are based only on observed inputs. Further, we introduce variable-rate feature masking during training to improve robustness to heterogeneous missingness patterns. We evaluate the approach on glioblastoma and lung squamous cell carcinoma with external validation across multiple cohorts, including a challenging setting with severe cross-cohort panel mismatch. Across these settings, SHIFT shows strong generalization and compares favorably with standard survival baselines and imputation-based approaches, while using a single model across differing feature sets. We also find that incorporating patients from incomplete cohorts during development can improve performance on external data, suggesting that partially observed cohorts need not be excluded from model building. These results support missingness-aware modeling as a practical strategy for multi-center survival prediction in precision oncology.

Muhammet Sami Yavuz, Ayhan Can Erdur, Sabri Mustafa Kahya +2

AI for Image-Guided Diagnosis and Therapy, School of Medicine and Health, Technical University of Munich (TUM), Munich, Germany · Munich Center for Machine Learning (MCML) · Department of Radiation Oncology, TUM University Hospital +4

Cancer Genomics Cancer Survival Prediction Transformer Survival Analysis Learning with Missing Data Oncology+2

Jul 1, 2026cs.CV

Foundation Models vs. Radiomics for Lung Computed Tomography: A Benchmark of Feature Extractors, Classification Heads, and Segmentation Choices

Radiomics is the established approach for CT-based lung cancer phenotyping, yet comparisons with foundation models rarely isolate contributions of feature extractor, classification head, and segmentation choice, or test cross-cohort robustness. We benchmark five feature extractors (Curia, Curia-2, DINOv3, Radiomics2D, Radiomics3D), seven classification heads (TabPFN, TabICL, XGBoost, CatBoost, Random Forest, logistic regression, Ridge), and three segmentation regimes on five tasks: tumor volume and stage classification, 2-year survival prediction, histology classification, and age prediction. Models are trained on LUNG1 (n=338) and evaluated on an internal test set (n=84) and the external LUNG2 cohort (n=211), with worst-case cross-cohort performance as the primary metric. The dominant design factor is task-dependent: segmentation drives volume and stage classification, while classifier choice drives survival, histology, and age prediction. Radiomics is competitive for tumor volume, tumor stage and survival (partly due to label-derivation effects for the former); Curia variants reach comparable peak scores for survival; DINOv3 falls slightly short across tasks. Patch and slice aggregation have negligible impact. We recommend Curia with tumor segmentation and a CatBoost head as a safe default, achieving the best mean rank across the three primary clinical tasks, though task-specific selection consistently outperforms any cross-task default. When tumor delineations are unavailable, Curia-2 with lung segmentation and logistic regression offers a competitive alternative. All pipelines use a two-stage design suited to small cohort sizes where end-to-end fine-tuning would risk overfitting.

Nils Neukirch, Martin Maurer, Nils Strodthoff

Division AI4Health, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, Oldenburg 26129, Niedersachsen, Germany · University Institute for Diagnostic and Interventional Radiology, Klinikum Oldenburg AöR, Rahel-Straus-Straße 10, Oldenburg 26133, Niedersachsen, Germany

Medical Imaging Foundation Models Cancer Survival Prediction Medical Image Classification Oncology Radiomics Computed Tomography+1

Jun 24, 2026cs.CV

JASPR: Joint Spatial Representation learning of histology and spatial genomics for improved virtual genomic screening and clinical prognostication

Recent studies have shown that spatial properties of tumors are critical for understanding disease biology and predicting patient outcomes. These spatial properties are increasingly uncovered through complementary modalities: spatial transcriptomics (ST) captures spatially-resolved molecular states, while hematoxylin and eosin-stained whole slide images (HE) reveal tissue morphology. While approaches are emerging to fuse these modalities, effective methods that learn not only joint representations but also incorporate spatial context across modalities are lacking. Here, we present JASPR (Joint Spatial Representation learning), a self-supervised deep learning framework that integrates HE images and ST data through a cross-modal reconstruction objective that incorporates spatial context within HE images and ST profiles. It employs shared modules to capture universal spatial properties across modalities, while modality-specific experts encode features unique to morphological and genomic data. We train and validate JASPR on breast cancer datasets, demonstrating that its learned joint representation substantially improves HE-based prediction of 9,248 genes and provides prognostic value for breast cancer outcomes.

Marija Pizurica, Eric Zimmermann, Neil Tenenholtz +5

Microsoft Research, Cambridge, MA, United States · Stanford University, CA, United States

Cancer Genomics Computational Pathology Spatial Transcriptomics Cross-Modal Representation Learning Cancer Survival Prediction Oncology+3

Jun 22, 2026cs.LG

Federated Survival Analysis in Healthcare: A Multi-Model Evaluation on Cross-Institutional Heterogeneous Breast Cancer Data

Survival analysis is central to clinical decision-making, yet reliable time-to-event models require large, diverse cohorts that are rarely available at a single institution, while privacy regulations restrict the centralization of patient data. Federated learning (FL) offers a privacy-preserving alternative by training shared models without exchanging raw data, but its effectiveness for survival modeling under realistic, heterogeneous conditions remains insufficiently understood. This paper presents a systematic, multi-model evaluation of federated survival analysis on a cross-institutional breast cancer cohort with naturally heterogeneous distributed clients. Three representative survival models, the Cox Proportional Hazards model, DeepSurv, and Random Survival Forest (RSF), are compared across centralized, local, and federated training, and three federated optimization strategies (FedAvg, FedProx, and FedAdam) are assessed for the gradient-based models. Results show that FL consistently outperforms local training and approaches, and occasionally exceeds, centralized performance, while RSF offers the best overall balance of discrimination, calibration, and robustness across heterogeneous clients. We further find that performance depends on the diversity of client distributions, and that FedAvg and FedProx are stronger and more stable than FedAdam. Based on these findings, we derive practical, decision-oriented guidelines mapping data, privacy, interpretability, and resource constraints to recommended model and training-paradigm choices for federated survival modeling in healthcare.

Natalia Moreno-Blasco, Anusha Ihalapathirana, Pekka Siirtola +1

Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland · Biomimetics and Intelligent Systems Group, University of Oulu, Oulu, Finland · Faculty of Engineering, University of Deusto, Bilbao, Spain

Cancer Survival Prediction Survival Analysis Oncology Federated Learning Heterogeneous Federated Learning

Jun 18, 2026cs.CV

HEad and neCK TumOR (HECKTOR) 2025: Benchmark of Segmentation, Diagnosis, and Prognosis in Multimodal PET/CT

Head and neck cancers (HNC) represent a significant global health burden, with accurate tumor delineation being essential for effective radiotherapy planning. The complexity of the oropharyngeal anatomy, combined with the heterogeneous appearance of tumors on imaging, makes manual segmentation time-intensive and subject to inter-observer variability. Beyond segmentation, predicting long-term clinical outcomes, such as recurrence-free survival (RFS), and determining human papillomavirus (HPV) status from noninvasive imaging, remain challenging yet clinically valuable goals. The HECKTOR 2025 challenge addresses these needs by establishing a comprehensive benchmark for automated HNC analysis using multimodal PET/CT imaging and electronic health records. Building on previous editions (2020-2022), this challenge features an expanded multi-institutional dataset comprising over 1,100 patients from 10 centers worldwide. Participants were tasked with three complementary objectives: (1) segmenting primary gross tumor volumes (GTVp) and metastatic lymph nodes (GTVn), (2) predicting recurrence-free survival, and (3) classifying HPV status. The challenge attracted 35 registered teams, with 15 final submissions evaluated on a held-out test set. Top-performing algorithms achieved a mean Dice similarity coefficient of 0.75 for segmentation, a concordance index of 0.66 for survival prediction, and a balanced accuracy of 0.56 for HPV classification. This paper presents a comprehensive analysis of the submitted methodologies, evaluates their performance across different lesion characteristics, and discusses their implications for clinical translation in automated oncology workflows and decision support systems.

Numan Saeed, Salma Hassan, Shahad Hardan +27

Mohamed bin Zayed University of Artificial Intelligence (MBZUAI), Abu Dhabi, UAE. · Amsterdam UMC, Amsterdam, The Netherlands. · The Netherlands Cancer Institute, Amsterdam, The Netherlands. +22

Cancer Survival Prediction PET/CT Imaging Medical Image Segmentation Oncology Medical Image Benchmarks

Jun 18, 2026cs.LG

Evidential Fusion Network for Multimodal Survival Prediction under Missing Modalities

Recent multimodal survival prediction models have demonstrated strong predictive performance by leveraging complementary information across modalities. However, such models generally assume data completeness and exhibit limited robustness toward missing modalities, which are frequently encountered in real-world clinical settings. We propose the Evidential Missing Modality Survival Fusion (EMMS) model for multimodal survival prediction under missing modalities. EMMS offers a straightforward, computationally effective approach to survival analysis without requiring a generative phase for missing data. By employing Dempster-Shafer theory and Gaussian Random Fuzzy Numbers for multimodal decision fusion, it considers both aleatoric and epistemic uncertainty alongside modality reliability for fusion. Moreover, the model treats missing modalities as vacuous evidence, preventing interference with available inputs and naturally reflecting increased uncertainty and calibrated predictions. Extensive experiments on four cancer datasets demonstrate state-of-the-art performance while providing calibrated and interpretable uncertainty estimates under incomplete multimodal observations, without introducing additional computational overhead.

Yucheng Xing, Hailan Mo, Zi Wang +2

National University of Singapore, Singapore · Imperial College London, London, UK

Missing-Modality Learning Uncertainty Quantification Cancer Survival Prediction Survival Analysis Dempster-Shafer Theory Uncertainty-Aware Multimodal Fusion+3

Jun 18, 2026cs.CV

Semantic-Anchored Evidential Fusion for Domain-Robust Whole-Slide Survival Analysis

Whole-slide images (WSIs) are widely used for computational cancer prognosis. However, most existing methods primarily focus on in-domain performance and fail to generalize across clinical centers. This limitation stems from their reliance on pixel-derived representations that are highly susceptible to domain-specific artifacts caused by staining protocols and scanner hardware. We hypothesize that high-level pathology semantics, such as tumor grade and micro-environmental architecture, provide a domain-invariant semantic representation that mirrors the robust diagnostic logic of human pathologists. Therefore, we propose a Semantic-Anchored Evidential Fusion Survival (SAEFS) framework, where SAEFS derives semantic anchors from WSIs via Visual Question Answering (VQA), employs a dual-stream WSI evidence extraction architecture, uses Dirichlet-based Subjective Logic to model uncertainty, and fuses semantic and visual evidence through a cautious conjunction rule to avoid overconfident fusion from correlated sources. Trained exclusively on one source domain and evaluated zero-shot across four unseen domains, SAEFS consistently outperforms state-of-the-art models both in prediction accuracy and reliability, improving the average C-index by 10.2%. Quantitative analyses further show that VQA-derived semantic features exhibit significantly lower cross-center divergence than pixel-derived features, highlighting their robustness for cross-center clinical applications.

Yucheng Xing, Ling Huang, Pei Liu +4

National University of Singapore, Singapore · Imperial College London, London, UK · Hunan University, Changsha, China

Computational Pathology Cancer Survival Prediction Domain Generalization Oncology Whole-Slide Image Analysis

Jun 17, 2026cs.LG

ChronoSurv: A Clinical Pathway-Guided Graph Framework for Multimodal Survival Analysis

Accurate survival prediction is essential for personalized treatment planning in head and neck cancer, yet remains challenging due to the heterogeneous and high-dimensional nature of multimodal clinical data. While deep survival models have improved predictive performance over classical statistical approaches, existing methods typically rely on static fusion strategies or temporally agnostic modeling, limiting their ability to capture structured clinical workflows. In this work, we propose ChronoSurv, a heterogeneous hierarchical directed graph framework for multimodal survival analysis. ChronoSurv represents patient care as a progression-aware clinical trajectory using directed graphs aligned with key diagnostic steps. A hierarchical topology incorporates fine-grained, coarse, and global representations, further supporting flexible adaptation to missing modalities, while heterogeneous message passing models complex and asymmetric relationships across modalities and clinical steps. Experimental results on two public datasets demonstrate that ChronoSurv achieves state-of-the-art discriminative performance while maintaining statistically reliable calibration. Comprehensive ablation studies further confirm the contribution of each architectural component, highlighting the potential of trajectory-aware graph modeling for multimodal survival prediction.

Hugo Miccinilli, Theo Di Piazza

Université Paris-Saclay, CentraleSupélec, MICS, France · University of Lyon, INSA Lyon, CREATIS, France

Cancer Survival Prediction Heterogeneous GNNs Survival Analysis Oncology Multimodal Survival Analysis Multimodal Graph Learning

Jun 12, 2026eess.IV

Trimodal Glioma Representation Alignment via Volumetric Contrastive Learning

Glioma grading and survival prediction require the integration of heterogeneous information collected at different spatial and biological scales. Histopathology describes tissue morphology, mRNA expression captures molecular activity, and magnetic resonance imaging provides a non-invasive view of tumor extent and radiological heterogeneity. Existing glioma prognosis models often combine only two of these sources, while their alignment objectives remain mostly pairwise. This paper introduces GLORIA, a novel trimodal framework for GLioma Omics - Radiology - hIstopathology Alignment. GLORIA processes whole-slide image regions, gene-expression profiles, and 3D MRI volumes through modality-specific encoders, projects them into a shared latent space, and aligns them with a Gramian contrastive loss that measures the volume spanned by the three modality embeddings. The aligned representations are fused through a cross-modal gating module and optimized jointly for three-class glioma grading and overall survival prediction. We evaluate GLORIA on a matched TCGA-GBM/LGG and BraTS21 cohort, comprising 132 patients with all three modalities. On the shared trimodal test set, GLORIA improves over the bimodal WSI-mRNA baseline in all the metrics considered.

Denise Marini, Eleonora Grassucci, Danilo Comminiello

Dept. of Information Engineering, Electronics, and Telecommunications, Sapienza University of Rome, Italy

Cancer Survival Prediction Cross-Modal Alignment Oncology Multimodal Survival Analysis Multimodal Contrastive Learning Multimodal Fusion

Jun 10, 2026cs.CV

Time-Conditioned and Multi-Time Survival Prediction from 2D PET/CT Projections in Lung Cancer

Accurate prediction of overall survival (OS) from positron emission tomography/computed tomography (PET/CT) can support personalized treatment and follow-up strategies in oncology. However, the impact of temporal modeling on imaging-based survival prediction remains insufficiently explored. We investigate how different temporal formulations influence survival prediction by developing two complementary approaches: Attention-guided Time-Conditioned Survival (ATCS) and Multi-Time Survival (MTS). We retrospectively analyzed pre-treatment PET/CT images from 848 patients with non-small cell lung cancer (NSCLC), including 556 for model development and 292 for held-out testing. A previously proposed Time-Conditioned Survival (TCS) model was used as a baseline. Models were trained using 5-fold cross-validation and evaluated on the test set using time-dependent area under the curve (AUC) at 6-month intervals from 0.5 to 5 years. Both ATCS and MTS outperformed the baseline TCS model, achieving mean AUCs of 0.794 and 0.793, respectively, compared to 0.767. ATCS performed better at earlier time points (0.5-3 years), whereas MTS performed better at later intervals (3.5-5 years). Combining tumor-specific and tissue-wise PET/CT features improved performance over either input alone. Finer temporal discretization improved short-term prediction, while coarser intervals provided more stable long-term estimates. These findings demonstrate that temporal modeling and input design influence PET/CT-based survival prediction. The proposed approaches enable time-specific survival estimation from pre-treatment imaging and may support improved risk stratification and clinical decision-making.

Ashish Chauhan, Sambit Tarai, Elin Lundström +3

Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden · National Academic Infrastructure for Supercomputing (NAISS), LinköpingJun University, Linköping, Sweden · Antaros Medical, Mölndal, Sweden +1

Cancer Survival Prediction Survival Analysis PET/CT Imaging Oncology