Survival Analysis

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Survival analysis estimates when an event may occur and how risk changes over time, even when follow-up ends before the event is observed. Methods range from Kaplan–Meier curves, Cox and accelerated failure-time models to random survival forests, neural hazard models, and newer in-context models pretrained on synthetic data. Current work applies these tools to longitudinal, multimodal, and clinical data, including competing risks, personalized treatment decisions, and causal effects. A central challenge is ensuring predictions are not only good at ranking risk but also calibrated, fair, and reliable when censoring or data distributions differ across settings.

Latest papers

106 papers14 papers in the last four weeks, up 250% on the four weeks before. 0.1% of all new papers.

Jun 1, 2026

Scalable Counterfactual Risk Estimation for Rare Events in Longitudinal Data

Estimating the causal effect of time-varying treatments on survival outcomes in large observational studies is computationally demanding, particularly when outcomes are rare. While g-formula-based methods such as the iterative conditional expectation (ICE) estimator provide a principled framework for longitudinal causal inference, they become computationally expensive, especially when bootstrap-based variance estimation is required. In addition, outcome rarity at each time point induces severe class imbalance, leading to instability and convergence issues in logistic regression and related models. To address these challenges, we propose a principled subsampling and reweighting strategy for longitudinal survival data that can be applied to a range of existing causal effect estimators in this setting, including the ICE estimator. The proposed method substantially reduces computational burden while preserving consistency and improving estimation stability in rare-outcome settings. We evaluate the method through simulations and validate it using a large-scale EHR cohort study on social and behavioral determinants of health (SBDH) and suicide risk, demonstrating its effectiveness for modeling rare outcomes in longitudinal data.

Xiaohui Yin, Avijit Mitra, Ying Zhou +2

University of Massachusetts Amherst Amherst, Massachusetts, USA · University of Massachusetts Lowell Lowell, Massachusetts, USA

Causal Effect Estimation Survival Analysis Longitudinal EHR Modeling Rare-Event Estimation

May 28, 2026

Evolving Features vs Evolving Entire Trees with GP for Interpretable Survival Analysis

Survival analysis concerns the task of predicting the time until an event occurs. Often used in the medical field, survival analysis deals with incomplete (i.e., censored) data, for instance, from patients who did not experience the event during the duration of the study. For practical use, both accuracy and interpretability are important. Survival trees are easy-to-follow survival models that split the patient cohort recursively into discrete patient groups. Whilst survival trees can capture complex relationships, they typically need to grow large, threatening interpretability. Moreover, survival trees are often built using greedy approaches that may overlook globally optimal split combinations, limiting predictive performance. Shallow survival trees require expressive, higher-order feature combinations to achieve competitive accuracy. We therefore use genetic programming to multi-objectively evolve inherently inspectable feature sets and study how they interact with different tree induction strategies. We further introduce an evolutionary approach that jointly optimises the survival tree structure and the non-linear split logic. Our findings demonstrate that evolutionary feature construction improves predictive performance across different tree induction strategies on two real-world datasets and two different survival tree depths. Given its speed and flexible presentation, the multi-objective evolution of entire trees likely holds the most future promise.

Thalea Schlender, Peter A. N. Bosman, Tanja Alderliesten

Leiden University Medical Center, Leiden, The Netherlands · Centrum Wiskunde & Informatica, Amsterdam, The Netherlands

Multi-Objective Evolutionary Optimization Survival Analysis Interpretable ML Genetic Programming

May 28, 2026

Deep Optimal Individualized Treatment Rules for Bivariate Survival Outcomes via Adaptive Prediction-Powered Learning

In randomized trials involving multiple treatments, bivariate survival outcomes present significant analytical challenges for making decisions. This paper addresses the problem of deriving optimal individualized treatment rules to maximize the joint survival probability beyond fixed time points

(t_1, t_2)

through deep neural networks, while accounting for right censoring. We propose a novel approach that models treatment rules via stochastic policies, coupling marginal accelerated failure time models via link function to capture bivariate dependence. To enhance robustness and effectiveness of decision making, we introduce an adaptive prediction-powered method that leverages auxiliary predictions from machine learning models.

Kun Ren, Yifan Cui, Wen Su

Department of Biostatistics, City University of Hong Kong · Center for Data Science, Zhejiang University

Survival Analysis Clinical Decision-Making

May 25, 2026

Towards end-to-end LLM-based censoring-aware survival analysis

Objective: Survival analysis is central to medical prediction, yet large language models (LLMs) are rarely used as end-to-end survival models because censoring prevents straightforward supervised fine-tuning. Here we present LLMSurvival, a framework that enables censoring-aware survival analysis with unmodified LLMs operating directly on tabular clinical data. Materials and Methods: LLMSurvival reformulates time-to-event prediction as pairwise ranking among comparable subjects, and derives test-time risk by aggregating comparisons against anchor individuals from the training cohort. Results: Across two clinical tasks (ICU mortality prediction in MIMIC-IV and fragility fracture prediction in a NewYork-Presbyterian/Weill Cornell Medicine cohort), LLMSurvival improves overall concordance over Cox proportional hazards modeling by 3.1% for ICU mortality and 0.5% for fracture risk, 2.1% on average for ICU mortality and 2.8% for fracture risk over three established deep learning survival models. Discussion: The results show that survival modeling with censoring can be made compatible with LLM fine-tuning through comparison-based reformulation. The framework demonstrates high portability and superior performance over expert curated scores like SAPS-II and FRAX scores across diverse clinical context. Furthermore, the framework supports local deployment, as compact, publicly available base models provide sufficient performance. Conclusion: The LLMSurvival framework serves as a proof of concept for an integrated, censoring-conscious approach to survival analysis via LLMs.

Yishu Wei, Hexin Dong, Yi Lin +3

Department of Population Health Science, Weill Cornell Medicine, New York, 10065, US · Department of Medicine, Weill Cornell Medicine, New York, 10065, US

Survival Analysis Mortality Prediction Medical LLMs

May 24, 2026

Multimodality Stacking with Blockwise missing values and application to the PIONeeR biomarkers study for prediction of resistance to immunotherapy

Integrating multimodal datasets in clinical oncology is frequently hindered by high dimensionality and blockwise missingness, where entire data sources are unavailable for specific patient subsets. Standard survival models often struggle with these gaps, leading to biased results or patient exclusion. We introduce Multimodality Stacking with Blockwise missing values (MSB), a late-fusion framework for survival analysis that independently models modality-specific features before aggregating predictions via a cross-validated stacking meta-learner. MSB was validated on the PIONeeR study (n=443 patients, 378 biomarkers across eight heterogeneous sources) to predict progression-free survival in advanced non-small cell lung cancer patients receiving immunotherapy. MSB yielded higher predictive performance (C-index) than baseline algorithms. Improvements varied by baseline strength: linear models showed a 15.9% increase (p<0.001 for the Wilcoxon signed-rank test), random survival forests gained 5.4% (p=0.002), and gradient boosting methods improved by 2.1% (p=0.030). Beyond discrimination, MSB reduced the generalization gap (train-test difference in 5 folds cross-validation repeated 3 times: 0.055 vs 0.380 for linear models). Permutation importance analysis identified routine laboratory markers, clinical features, and PD-L1 expression as primary predictive drivers. Missing block indicators showed negligible importance, suggesting the model learned from biomarker values rather than data availability patterns. MSB provides a statistically validated framework for multimodal survival prediction with blockwise missingness. By enabling systematic biomarker evaluation without requiring complete data, MSB offers a practical tool for predictive modeling in biomedical research, pending external validation. Implementation is available at https://github.com/MohamedBoussena/MSB under Inria license.

Mohamed Boussena, Florence Monville, Jacques Fieschi-Meric +8

Inria – Inserm team COMPO, COMPutational pharmacology and clinical Oncology, Centre Inria Sophia Antipolis - M´editerran´ee, Centre de Recherches en Canc´erologie de Marseille, Inserm U1068, CNRS UMR7258, Institut Paoli-Calmettes, Pharmacy faculty, Aix-Marseille University · Veracyte SAS, Marseille, France · Assistance Publique-Hˆopitaux de Marseille (APHM), Marseille, France +4

Missing-Modality Learning Cancer Survival Prediction Survival Analysis Clinical Outcome Prediction Oncology Multimodal Survival Analysis+1

May 21, 2026

KAPLAN: Kolmogorov-Arnold Prognostic Learnable Activation Networks for Survival Analysis

Survival analysis aims to model how covariates and time jointly shape the time-to-event distribution under right censoring. Classical methods such as the Cox model and generalised additive models (GAMs) require interactions and time-varying effects to be manually specified, which is increasingly impractical on rich clinical datasets. We introduce KAPLAN-HR, a B-spline Kolmogorov-Arnold Network (KAN) for nonparametric estimation of the conditional hazard as a joint function of covariates and time. A single-layer KAPLAN-HR model recovers a GAM, while deeper architectures capture interactions and time-varying effects through composition. We establish a convergence rate for the nonparametric KAN hazard estimator that depends only on the smoothness of the underlying KAN representation and not on the covariate dimension, thereby mitigating the curse of dimensionality for KAN-representable targets. In evaluations over six clinical benchmark datasets, KAPLAN-HR matches or exceeds the predictive performance of established statistical and deep learning survival methods.

Stelios Boulitsakis Logothetis, Angela Wood, Pietro Liò

University of Cambridge

Survival Analysis Kolmogorov-Arnold Networks

May 21, 2026

FederatedRSF : Federated Random Survival Forests for Partially Overlapping Medical Data

Multi-center survival prediction can improve robustness and generalizability, yet privacy regulations and institutional governance often prevent pooling patient-level clinical and genomic data across institutions. In practice, deployment is further complicated by feature-space heterogeneity, in which sites collect different covariates or use different sequencing panels, resulting in only partially overlapping feature sets. We present FederatedRSF, a Python package that implements federated random survival forests, aggregating locally trained survival trees and redistributing only feature-compatible trees to each site, enabling inference with partial overlap without sharing raw data. We evaluate FederatedRSF on the GBSG2 breast cancer cohort distributed with the scikit-survival package, simulating feature heterogeneity across clients by withholding subsets of features, and assessing discrimination using Harrell's concordance index (C-Index) under repeated cross-validation and site-splits. The results demonstrated that the federated model can achieve performance comparable to that of the centralized training setting.

Maryam Moradpour, Jonas Harriehausen, Amirreza Aleyasin +3

Institute for Predictive Deep Learning in Medicine and Healthcare, Justus Liebig University Gießen, Germany · Hessian Center for Artificial Intelligence (hessian.AI), Darmstadt, Germany · Department of Medical Informatics, University Medical Center Göttingen, Germany +1

Federated Learning Aggregation Cancer Survival Prediction Healthcare Survival Analysis Privacy-Preserving ML Federated Learning+1

May 21, 2026

SDPM: Survival Diffusion Probabilistic Model for Continuous-Time Survival Analysis

Survival analysis aims to estimate a time-to-event distribution from data with censored observations. Many existing methods either impose structural assumptions on the hazard function or discretize the time axis, which may limit flexibility and introduce approximation errors. We propose the Survival Diffusion Probabilistic Model (SDPM), a generative approach to continuous-time survival analysis. SDPM models the conditional distribution of the survival outcome, represented by the pair of observed time and censoring indicator,

\mathbb{P}(T,δ\mid \mathbf{x})

, using a denoising diffusion model. Under the assumption of conditionally independent censoring, conditional samples generated by the model can be transformed into survival function estimates using the Kaplan-Meier estimator. This formulation avoids parametric assumptions on the event-time distribution and does not require a discretization of the output time space. The model operates in a transformed target space, using standardized log-times and a continuous Gaussian-mixture representation of the censoring indicator. We evaluate SDPM on ten real survival datasets and compare it with five strong baselines, including tree-based, boosting-based, and neural survival models. Results show that SDPM achieves competitive predictive performance across C-index, integrated time-dependent AUC, and integrated Brier score. A study on synthetic Cox-Weibull data demonstrates that SDPM can recover the shape of an underlying continuous survival distribution more accurately than a strong nonparametric baseline when sufficiently many samples are generated. An ablation study confirms the importance of the proposed target-space transformations, which improve event-rate calibration, reduce invalid generated times, and provide consistent gains in predictive discrimination. Codes implementing the proposed model are publicly available.

Stanislav R. Kirpichenko, Andrei V. Konstantinov, Lev V. Utkin

Peter the Great St.Petersburg Polytechnic University

Survival Analysis Conditional Diffusion Models Diffusion Models

May 20, 2026

HDMoE: A Hierarchical Decoupling-Fusion Mixture-of-Experts Framework for Multimodal Cancer Survival Prediction

Multimodal survival prediction, a crucial yet challenging task, demands the integration of multimodal medical data (\eg Whole Slide Images (WSIs) and Genomic Profiles) to achieve accurate prognostic modeling. Given the inherent heterogeneity across modalities, the feature decoupling-fusion paradigm has emerged as a dominant approach. However, these methods have the following shortcomings: (1) fail to reduce the redundant information of modality features before decoupling, which negatively affects the feature decoupling and fusion effect;(2) lack the ability to model the fine-grained relationships of the features and capture the local information interactions between intra- and inter-modality features. To address these issues, we propose a Hierarchical Decoupling-Fusion Mixture-of-Experts (HDMoE) framework with two levels of MoE and Random Feature Reorganization (RFR) modules.In the first-level MoE, shared experts and routed experts are employed to remove redundant information and extract fine-grained specific features within each modality, while the second-level MoE facilitates fine-grained inter-modality feature decoupling. Besides, we design two RFR modules following each level of MoE to finely fuse intra- and inter-modality features, which can help the model capture more fine-grained relationships between modalities. Extensive experimental results on our private Liver Cancer (LC) and three TCGA public datasets confirm the effectiveness of our proposed method. Codes are available at https://github.com/ZJUMAI/HDMoE.

Huayi Wang, Haochao Ying, Yuyang Xu +5

Zhejiang University Hangzhou, China · Xinjiang University Urumqi, China · Hangzhou City University Hangzhou, China +1

Cancer Survival Prediction Survival Analysis Oncology Multimodal Survival Analysis Mixture-of-Experts Models Multimodal Fusion

May 18, 2026

Adaptive Experimentation for Censored Survival Outcomes

Adaptive experimentation enables efficient estimation of causal effects, but existing methods are not designed for survival data with censoring, where event times are only partially observed (e.g., overall survival in cancer trials but with dropout). In this paper, we develop a novel framework for adaptive experimentation to estimate causal effects under right censoring. For this, we derive the semiparametric efficiency bound for the average survival effect curve as a function of the treatment allocation policy and thereby obtain a closed-form efficiency-optimal allocation policy. The policy generalizes classical Neyman allocation to survival settings by prioritizing patient strata where both event and censoring dynamics induce high uncertainty. Building on this, we propose the Adaptive Survival Estimator (ASE), an adaptive framework that learns the allocation policy and estimates the average survival effect curve sequentially. Our framework has three main benefits: (i) it accommodates arbitrary machine learning models for nuisance estimation; (ii) it is guided by a closed-form efficiency-optimal allocation policy; and (iii) it admits strong theoretical guarantees, including asymptotic normality via a martingale central limit theorem. We demonstrate our framework across various numerical experiments to show consistent efficiency gains over uniform randomization and censoring-agnostic baselines.

Yuxin Wang, Dennis Frauen, Jonas Schweisthal +3

LMU Munich Munich Center of Machine Learning (MCML)

Causal Effect Estimation Survival Analysis

May 15, 2026

Isotonic Survival Regression: Calibrated Survival Distributions from Deep Cox Models

Time-to-event data is widespread across the life sciences and engineering, but it is typically encountered together with censoring, which complicates the application of standard machine learning methods. Deep Cox models have emerged as a popular method for analyzing time-to-event data because they gracefully handle censoring and can be used with unstructured data such as clinical text reports, genomic sequences, and pathology images. However, their predicted survival probabilities are often poorly calibrated, thus limiting their practical utility. In this paper, we propose a novel post hoc calibration method for Deep Cox models that uses isotonic regression to refine predicted survival probabilities without affecting discriminative power. We establish favorable theoretical guarantees, including a double-robustness property and asymptotic calibration. Experiments on synthetic and real-world clinical data demonstrate the empirical effectiveness of our method.

Anchit Jain, Kevin Zhang, Stephen Bates

EECS, MIT, Cambridge MA, USA.

Post-Hoc Calibration Survival Analysis Isotonic Regression

May 15, 2026

A Scalable Nonparametric Continuous-Time Survival Model through Numerical Quadrature

Flexible continuous-time survival modeling is critical for capturing complex time-varying hazard dynamics in high-dimensional data; however, training such models remains challenging due to the intractable integral required for likelihood estimation. We introduce QSurv, a scalable deep learning framework that enables nonparametric continuous-time modeling without relying on time discretization or restrictive distributional assumptions. We propose a training objective based on Gauss-Legendre numerical quadrature, which approximates the cumulative hazard with high-order accuracy while facilitating efficient end-to-end training via standard backpropagation. Furthermore, to effectively capture non-stationary hazard dynamics in complex architectures, we introduce time-conditioned low-rank adaptation, a mechanism that conditions general neural backbones on time by dynamically modulating weights via low-rank updates. We provide theoretical analysis establishing approximation error bounds for cumulative-hazard evaluation. Comprehensive experiments across synthetic benchmarks, large-scale real-world tabular datasets, and high-dimensional medical imaging tasks demonstrate that QSurv achieves competitive predictive performance with advantages in instantaneous hazard function estimation, enabling more interpretable characterization of time-varying risk patterns.

Chaeyeon Lee, Sehwan Kim, Hyungrok Do

Department of Statistics · Ewha Womans University · Seoul, Korea +3

Numerical Integration Survival Analysis

May 15, 2026

SurvivalPFN: Amortizing Survival Prediction via In-Context Bayesian Inference

Survival analysis provides a powerful statistical framework for modeling time-to-event outcomes in the presence of censoring. However, selecting an appropriate estimator from the many specialized survival approaches often requires substantial methodological and domain expertise. We introduce SurvivalPFN, a prior-data fitted network that amortizes Bayesian inference for censored observations through in-context learning. SurvivalPFN is pretrained on a diverse family of synthetic, identifiable, and right-censored data-generating processes, enabling it to amortize survival analysis in a single forward pass during inference. As a result, the model adapts to the effective complexity of each dataset without task-specific training or hyperparameter tuning, avoids restrictive parametric assumptions, and produces calibrated survival distributions. In a large-scale benchmark spanning 61 datasets, 21 methods, and 5 evaluation metrics, SurvivalPFN achieves strong predictive performance and often improves upon established survival models. These results suggest that SurvivalPFN offers a principled and practical foundation model for survival analysis, with potential applications in high-impact domains such as healthcare, finance, and engineering (https://github.com/rgklab/SurvivalPFN).

Shi-ang Qi, Vahid Balazadeh, Michael Cooper +2

Vector Institute · University of Toronto · University of Alberta +1

Amortized Inference Survival Analysis Bayesian Inference Prior-Data Fitted Networks Mortality Prediction

May 12, 2026

Attention-Based Multimodal Survival Prediction with Cross-Modal Bilinear Fusion

We propose a novel multimodal deep learning framework for patient-level survival prediction, which integrates whole-slide histology features, RNA-seq expression profiles, and clinical variables. Our architecture combines an ABMIL module~\cite{ilse2018attention} for slide-level representation with feedforward encoders for RNA and clinical data. These embeddings are then integrated through low-rank bilinear cross-modal fusion~\cite{liu2018efficient} to model conditional interactions across modalities while controlling parameter growth. The model outputs continuous risk scores that are subsequently mapped to survival times using a nonparametric calibration procedure based on the Kaplan--Meier estimator~\cite{kaplan1958nonparametric}. By decomposing multimodal reasoning into independent pairwise interactions, the proposed fusion design promotes structural interpretability and parameter efficiency compared with full tensor and hierarchical fusion strategies. Experiments on the CHIMERA challenge dataset demonstrate improved predictive performance over concatenation-based baselines and competitive generalization on hidden evaluation cohorts. These results indicate that the proposed framework is a promising approach for multimodal survival prediction in HR-NMIBC. The implementation is publicly available at https://github.com/hassancpu/ChimeraChallenge2025_Task_3.

Hassan Keshvarikhojasteh, Josien P. W. Pluim, Mitko Veta

Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands

Representation Learning Cancer Survival Prediction Survival Analysis Oncology Multimodal Survival Analysis Multimodal Fusion

May 12, 2026

Causal Fairness for Survival Analysis

In the data-driven era, large-scale datasets are routinely collected and analyzed using machine learning (ML) and artificial intelligence (AI) to inform decisions in high-stakes domains such as healthcare, employment, and criminal justice, raising concerns about the fairness behavior of these systems. Existing works in fair ML cover tasks such as bias detection, fair prediction, and fair decision-making, but largely focus on static settings. At the same time, fairness in temporal contexts, particularly survival/time-to-event (TTE) analysis, remains relatively underexplored, with current approaches to fair survival analysis adopting statistical fairness definitions, which, even with unlimited data, cannot disentangle the causal mechanisms that generate disparities. To address this gap, we develop a causal framework for fairness in TTE analysis, enabling the decomposition of disparities in survival into contributions from direct, indirect, and spurious pathways. This provides a human-understandable explanation of why disparities arise and how they evolve over time. Our non-parametric approach proceeds in four steps: (1) formalizing the necessary assumptions about censoring and lack of confounding using a graphical model; (2) recovering the conditional survival function given covariates; (3) applying the Causal Reduction Theorem to reframe the problem in a form amenable to causal pathway decomposition; (4) estimating the effects efficiently. Finally, our approach is used to analyze the temporal evolution of racial disparities in outcome after admission to an intensive care unit (ICU).

Drago Plecko

Department of Statistics & Data Science UCLA

Causal Mediation Analysis Survival Analysis Algorithmic Fairness Causal Inference

May 7, 2026

Spend Where It Counts: Dynamic Budget Allocation for Multi-Turn LLM Evaluation

Evaluating and predicting the performance of large language models (LLMs) in multi-turn conversational settings is critical yet computationally expensive; key events---e.g., jailbreaks or successful task completion by an agent---often emerge only after repeated interactions. These events might be rare and, under any feasible computational budget, remain unobserved. Recent conformal survival frameworks construct reliable lower predictive bounds (LPBs) on the number of iterations to trigger the event of interest, but rely on static budget allocation that prohibits adaptivity in multi-turn setups. To address this, we introduce Dynamic Allocation via PRojected Optimization (DAPRO), a theoretically valid dynamic budget allocation framework for bounding the time-to-event in multi-turn LLM interactions. We prove that DAPRO satisfies the expected budget constraint and provides distribution-free, finite-sample coverage guarantees without requiring the conditional independence between censoring and event times assumed by prior conformal survival approaches. A key theoretical contribution is a novel coverage bound that scales with the square root of the mean censoring weight over only a subset of the samples rather than the worst-case weight, yielding tighter guarantees than prior work. Furthermore, DAPRO can be employed to obtain unbiased estimates of population-level evaluation metrics, such as the jailbreak rate, under limited computing resources. Comprehensive experiments across agentic task success, LLM jailbreaks, toxic content generation, and RAG hallucinations demonstrate that DAPRO achieves coverage closer to the nominal level with lower variance than static baselines, while not exceeding the budget constraint in expectation. Project website: https://shai128.github.io/dapro/

Shai Feldman, Yaniv Romano

Department of Computer Science, Technion IIT, Israel · Department of Electrical and Computer Engineering, Technion IIT, Israel

LLM Evaluation Language Model Safety Evaluation Survival Analysis

May 5, 2026

TabSurv: Adapting Modern Tabular Neural Networks to Survival Analysis

Survival analysis on tabular data is a well-studied problem. However, existing deep learning methods are often highly task-specific, which can limit the transfer of new approaches from other domains and introduce constraints that may affect performance. We propose TabSurv, an approach that adapts modern tabular architectures to survival analysis using either the Weibull distribution or non-parametric survival prediction. TabSurv optimizes SurvHL, a novel histogram loss function supporting censored data. In addition to a baseline feed-forward network, we implement deep ensembles of MLPs for survival analysis within TabSurv. In contrast to prior work, the ensemble components are trained in parallel, optimizing survival distribution parameters before averaging, which promotes diversity across ensemble component predictions. We perform a comprehensive empirical evaluation of different proposed architectures on 10 diverse real-world survival datasets. Our results show that TabSurv consistently outperforms on average established classical and deep learning baselines, such as RSF, DeepSurv, DeepHit, SurvTRACE. Notably, deep ensembles with Weibull parametrization instead of non-parametric models achieve the highest average rank by C-index. Overall, our study clarifies how modern tabular neural networks can be adapted and trained to tackle survival analysis problems, offering a strong and reliable approach. The TabSurv implementation is publicly available.

Stanislav Kirpichenko, Andrei Konstantinov, Lev Utkin

Higher School of Artificial Intelligence Technologies, Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia

Survival Analysis Deep Ensembles Tabular ML

Apr 30, 2026

PROMISE-AD: Progression-aware Multi-horizon Survival Estimation for Alzheimer's Disease Progression and Dynamic Tracking

Individualized Alzheimer's disease (AD) progression prediction requires models that use irregular visits, account for censoring, avoid diagnostic leakage, and provide calibrated horizon risks. We propose PROgression-aware MultI-horizon Survival Estimation for Alzheimer's Disease (PROMISE-AD), a leakage-safe survival framework for predicting conversion from cognitively normal (CN) to mild cognitive impairment (MCI) and from MCI to AD dementia using ADNI/TADPOLE tabular histories. PROMISE-AD converts pre-index visits into tokens with standardized measurements, missingness masks, longitudinal changes, time-normalized slopes, visit timing, and non-diagnostic categorical attributes. A temporal Transformer fuses global, attention-pooled, and latest-visit representations to estimate a progression score and latent discrete-time mixture hazards. Training combines survival likelihood, horizon-specific focal risk loss, progression ranking, hazard smoothness, and mixture-balance regularization, followed by validation-set isotonic calibration for 1-, 2-, 3-, and 5-year risks. In held-out testing across three seeds, PROMISE-AD achieved an integrated Brier score (IBS) of 0.085

\pm

0.012, C-index of 0.808

\pm

0.015, and mean time-dependent AUC of 0.840

\pm

0.081 for CN-to-MCI conversion, yielding the lowest IBS among compared methods. For MCI-to-AD conversion, PROMISE-AD achieved the highest C-index (0.894

\pm

0.018) and near-ceiling 5-year discrimination (AUROC 0.997

\pm

0.003; AUPRC 0.999

\pm

0.001), although some baselines had lower IBS. Ablations and interpretability supported longitudinal change features, fused temporal representations, mixture hazards, cognitive and functional measures, APOE4 status, and recent conversion-proximal visits. These findings suggest that progression-aware survival modeling can provide interpretable multi-horizon AD conversion risk estimates.

Qing Lyu, Jeremy Hudson, Mohammad Kawas +3

Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06510 USA · Department of Radiology Oncology, Wake Forest University School of Medicine, Winston-Salem, NC 27157 USA · Department of Applied Mathematics & Statistics and Department of Computer Science, Stony Brook University, Stony Brook, NY 11794 USA

Alzheimer's Disease Survival Analysis Clinical Outcome Prediction Alzheimer's Disease Progression Prediction Clinical Risk Prediction Disease Progression Modeling

Apr 27, 2026

Benchmarking Pathology Foundation Models for Breast Cancer Survival Prediction

Pathology foundation models (PFMs) have recently emerged as powerful pretrained encoders for computational pathology, enabling transfer learning across a wide range of downstream tasks. However, systematic comparisons of these models for clinically meaningful prediction problems remain limited, especially in the context of survival prediction under external validation. In this study, we benchmark widely used and recently proposed PFMs for breast cancer survival prediction from whole-slide histopathology images. Using a standardized pipeline based on patch-level feature extraction and a unified survival modeling framework, we evaluate model representations across three independent clinical cohorts comprising more than 5,400 patients with long-term follow-up. Models are trained on one cohort and evaluated on two independent external cohorts, enabling a rigorous assessment of cross-dataset generalization. Overall, H-optimus-1 achieves the strongest survival prediction performance. More broadly, we observe consistent generational improvements across model families, with second-generation PFMs outperforming their first-generation counterparts. However, absolute performance differences between many recent PFMs remain modest, suggesting diminishing returns from further scaling of pretraining data or model size alone. Notably, the compact distilled model H0-mini slightly outperforms its larger teacher model H-optimus-0, despite using fewer than 8% of the parameters and enabling significantly faster feature extraction. Together, these results provide the first large-scale, externally validated benchmark of PFMs for breast cancer survival prediction, and offer practical guidance for efficient deployment of PFMs in clinical workflows.

Fredrik K. Gustafsson, Constance Boissin, Johan Vallon-Christersson +2

Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden · Division of Oncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden · Department of Engineering Science, University of Oxford, Oxford, UK +1

Cancer Survival Prediction Survival Analysis Pathology Foundation Models Oncology Medical Image Benchmarks Whole-Slide Image Analysis

Apr 27, 2026

Heterogeneous Variational Inference for Markov Degradation Hazard Models: Discretized Mixture with Interpretable Clusters

Bayesian finite mixture models can identify discrete risk clusters (low-risk vs. high-risk equipment), but face three critical bottlenecks: (1) insufficient degradation signals from coarse state discretization, (2) unstable cluster identification when data inherently supports fewer clusters than explored, and (3) computational infeasibility of Markov Chain Monte Carlo (MCMC) methods for production deployment (7+ hours per model). We propose a practical framework combining (1) 8-state global percentile discretization that amplifies degradation events, (2) 30-dimensional feature engineering integrating statistical trends (22 features), continuous health indicators, and text embeddings (PCA-compressed to 3 dimensions), (3) interpretable model selection rules enforcing minimum cluster share and separation alongside WAIC, and (4) Automatic Differentiation Variational Inference (ADVI) with full-rank covariance for stable, fast estimation. Applied to 280 industrial pump equipment with 104,703 inspection records, we demonstrate: (1) Random effect models (baseline) show ADVI and NUTS produce nearly identical estimates with 15

\times

speedup, validating ADVI accuracy. (2) Finite mixture models identify optimal number of clusters with interpretability constraints. (3) NUTS exhibits severe convergence issues and label switching, while ADVI provides stable results in 84

\times

less time. We contributed that (1) First demonstration that fine-grained state discretization (8-state) is essential for mixture model stability in survival analysis.(2) Comprehensive feature engineering strategy combining statistical, continuous, and semantic signals. (3) Practical interpretability rules preventing overfitting in automated model selection. (4) Empirical evidence that ADVI outperforms NUTS for finite mixture models in terms of convergence, stability, and computational efficiency.

Takato Yasuno

Digital Business Department, Yachiyo Engineering Co., Ltd.

Latent Variable Models Markov Models Bayesian Mixture Models Survival Analysis Predictive Maintenance Variational Inference

Apr 27, 2026

PathMoG: A Pathway-Centric Modular Graph Neural Network for Multi-Omics Survival Prediction

Cancer survival prediction from multi-omics data remains challenging because prognostic signals are high-dimensional, heterogeneous, and distributed across interacting genes and pathways. We propose PathMoG, a pathway-centric modular graph neural network for multi-omics survival prediction. PathMoG reorganizes genome-scale inputs into 354 KEGG-informed pathway modules, introduces a Hierarchical Omics Modulation module to condition gene-expression representations on mutation, copy number variation, pathway, and clinical context, and uses dual-level attention to capture both intra-pathway driver signals and inter-pathway clinical relevance. We evaluated PathMoG on 5,650 patients across 10 TCGA cancer types and observed consistent improvements over representative survival baselines. The framework further provides gene-level, pathway-level, and patient-level interpretability, supporting biologically grounded and clinically relevant risk stratification.

Di Wang, Chupei Tang, Junxiao Kong +3

1Cuiying Honors College, Lanzhou University, China · School of Mathematics and Statistics, Lanzhou University, China · School of Mathematics and Statistics, Lanzhou University, China and Shanghai Innovation Institute +1

Survival Analysis Graph Neural Networks Cancer Survival Prediction Cancer Genomics Oncology Modular Neural Networks+1

Apr 22, 2026

Online Survival Analysis: A Bandit Approach under Cox PH Model

Survival analysis is a widely used statistical framework for modeling time-to-event data under censoring. Classical methods, such as the Cox proportional hazards (Cox PH) model, offer a semiparametric approach to estimating the effects of covariates on the hazard function. Despite its importance, survival analysis has been largely unexplored in online settings, particularly within the bandit framework, where decisions must be made sequentially to optimize treatments as new data arrive over time. In this work, we take an initial step toward integrating survival analysis into a purely online learning setting under the Cox PH model, addressing key challenges including staggered entry, delayed feedback, and right censoring. We adapt three canonical bandit algorithms to balance exploration and exploitation, with theoretical guarantees of sublinear regret bounds. Extensive simulations and semi-real experiments using SEER cancer data demonstrate that our approach enables rapid and effective learning of near-optimal treatment policies.

Yang Xu, Wenbin Lu, Rui Song

Department of Statistics · North Carolina State University

Multi-Armed Bandits Survival Analysis

Apr 13, 2026

Observing the unobserved confounding through its effects: toward randomized trial-like estimates from real-world survival data

Background: Randomized controlled trials (RCTs) are costly, time-consuming, and often infeasible, while treatment-effect estimation from observational data is limited by unobserved confounding. Methods: We developed a three-step framework to address unobserved confounding in observational survival data. First, we infer a latent prognostic factor (U) from restricted mean survival time (RMST) discrepancies between patients with similar observed factors, the same treatment, and divergent outcomes, leveraging the idea that the aggregate effect of unmeasured factors can be inferred even if individual factors cannot. Second, we balance U with observed baseline covariates using prognostic matching, entropy balancing, or inverse probability of treatment weighting. Third, we apply multivariable survival analysis to estimate hazard ratios (HRs). We evaluated the framework in three observational cohorts with RCT benchmarks, two RCT cohorts, and six multicenter observational cohorts. Results: In three observational cohorts (nine comparisons), balancing U improved agreement with trial HRs in all cases; in the strongest settings, it reduced absolute log-HR error by approximately ten-fold versus using observed covariates alone (mean reduction 0.344; p=0.001). In two RCT cohorts, U was balanced across arms (most SMDs <0.1) and adjustment had minimal impact on log-HRs (mean absolute change 0.08). Across six multicenter cohorts, balancing U within centers reduced cross-center dispersion in chemotherapy log-HR estimates (mean reduction 0.147; p=0.016); when populations were directly balanced across centers to account for case-mix differences, cross-center survival differences were narrowed in 75%-100% of comparisons. Conclusions: Inferring and balancing a latent prognostic signal may reduce unobserved confounding and improve treatment-effect estimation from real-world data.

Vasiliki Stoumpou, Dimitris Bertsimas, Samuel Singer +1

Operations Research Center, Massachusetts Institute of Technology, Cambridge, MA, USA · Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA · Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA +1

Causal Inference with Unobserved Confounding Causal Effect Estimation Causal Inference Survival Analysis

Apr 10, 2026

Investigating Trustworthiness of Nonparametric Deep Survival Models for Alzheimer's Disease Progression Analysis

Alzheimer's Dementia (AD) is a progressive neurodegenerative disease marked by irreversible decline, making reliable modeling of its progression essential for effective patient care. Progression-aware methods such as survival analysis are therefore crucial tools for the early detection and monitoring of AD. Recent advancements in deep learning have demonstrated remarkable performance in survival tasks, but alarmingly fewer studies have been conducted in the domain of AD. Further, the studies that do exist do not consider learned bias within the model itself, which could result in unfair and unreliable predictions toward certain marginalized groups. As such, we conduct a rigorous study of fairness in AD progression analysis along with a thorough feature importance study to determine the characteristics which are most important for reliable AD predictions. Furthermore, we propose two novel fairness metrics, called Time-Dependent Concordance Impurity and Kaplan-Meier Fairness, to quantify bias with respect to sensitive attributes such as sex, race, and education in nonparametric survival models. Our study demonstrates that while deep learning powered survival models are robust tools which can aid clinicians in AD care decisions, they often exhibit considerable bias, representing important avenues for future research.

Jacob Thrasher, Kaitlyn Heintzelman, Peter Martone +4

West Virginia University Morgantown, USA · University of Aberdeen Aberdeen, Scotland

Alzheimer's Disease Progression Prediction Algorithmic Fairness Survival Analysis Feature Attribution

Apr 10, 2026

An Auditable Policy-Simulation Framework for Student Dropout in Intervention-Free Data

This study proposes a temporal modeling framework with a counterfactual policy-simulation layer for student dropout in higher education, using LMS engagement data and administrative withdrawal records. Dropout is operationalized as a time-to-event outcome at the enrollment level; weekly risk is modeled in discrete time via penalized, class-balanced logistic regression over person--period rows. Under a late-event temporal holdout, the model attains row-level AUCs of 0.8350 (train) and 0.8405 (test), with aggregate calibration acceptable but sparsely supported in the highest-risk bins. Ablation analyses indicate performance is sensitive to feature set composition, underscoring the role of temporal engagement signals. A scenario-indexed policy layer produces survival contrasts

ΔS(T)

under an explicit trigger/schedule contract: positive contrasts are confined to the shock branch (

T_{\rm policy}=18

: 0.0102, 0.0260, 0.0819), while the mechanism-aware branch is negative (

ΔS_{\rm mech}(18)=-0.0078

,

ΔS_{\rm mech}(38)=-0.0134

). A subgroup analysis by gender quantifies scenario-induced survival gaps via bootstrap; contrasts are directionally stable but small. Results are not causally identified; they demonstrate the framework's capacity for internal structural scenario comparison under observational data constraints.

Rafael da Silva, Jeff Eicher, Gregory Longo

Applied Data Science Program, Eastern University, St. Davids, PA, USA.

Educational Data Mining Survival Analysis

Apr 10, 2026

A Unified Survival Benchmark for Temporal Dropout Risk Prediction in Learning Analytics

Student dropout is a persistent concern in Learning Analytics, yet comparative studies frequently evaluate predictive models under heterogeneous protocols, prioritizing discrimination over temporal interpretability and calibration. This study introduces a survival-oriented benchmark for temporal dropout risk modelling using the Open University Learning Analytics Dataset (OULAD). Two arms are compared: Family A: Dynamic Weekly, with models in person-period representation, and Family B: Static Early-Window, with an expanded roster of families: tree-based survival, parametric, and neural models. The evaluation protocol integrates four analytical layers: predictive performance, ablation, explainability, and calibration. Results are reported within each family separately, because a single numerical cross-family ranking would conflate genuine model differences with artifacts of temporal representation, to which survival metrics are known to be sensitive. Within Family B, Random Survival Forest showed the highest point estimates for time-dependent concordance and the lowest Brier scores across all three horizons; within Family A, Poisson Piecewise-Exponential showed the lowest point estimate for integrated Brier score within a tight five-model cluster. No-refit bootstrap resampling qualifies these positions as directional signals, not claims of strict superiority. Ablation and explainability analyses converged, across all models, on a shared finding: the dominant predictive signal was not primarily demographic or structural, but temporal and behavioral. Calibration corroborated this pattern in the better-discriminating models, except for XGBoost AFT, the sole outlier (analyzed in the Discussion). These results support unified, multi-dimensional benchmarking in Learning Analytics and situate dropout risk as a temporal-behavioral process rather than a function of static background attributes.

Rafael da Silva, Jeff Eicher, Gregory Longo

Applied Data Science Program, Eastern University, St. Davids, PA, USA.

Educational Data Mining Survival Analysis

Apr 8, 2026

Time-driven Survival Analysis from FDG-PET/CT in Non-Small Cell Lung Cancer

Purpose: Automated medical image-based prediction of clinical outcomes, such as overall survival (OS), has great potential in improving patient prognostics and personalized treatment planning. We developed a deep regression framework using tissue-wise FDG-PET/CT projections as input, along with a temporal input representing a scalar time horizon (in days) to predict OS in patients with Non-Small Cell Lung Cancer (NSCLC). Methods: The proposed framework employed a ResNet-50 backbone to process input images and generate corresponding image embeddings. The embeddings were then combined with temporal data to produce OS probabilities as a function of time, effectively parameterizing the predictions based on time. The overall framework was developed using the U-CAN cohort (n = 556) and evaluated by comparing with a baseline method on the test set (n = 292). The baseline utilized the ResNet-50 architecture, processing only the images as input and providing OS predictions at pre-specified intervals, such as 2- or 5-year. Results: The incorporation of temporal data with image embeddings demonstrated an advantage in predicting OS, outperforming the baseline method with an improvement in AUC of 4.3%. The proposed model using clinical + IDP features achieved strong performance, and an ensemble of imaging and clinical + IDP models achieved the best overall performance (0.788), highlighting the complementary value of multimodal inputs. The proposed method also enabled risk stratification of patients into distinct categories (high vs low risk). Heat maps from the saliency analysis highlighted tumor regions as key structures for the prediction. Conclusion: Our method provided an automated framework for predicting OS as a function of time and demonstrates the potential of combining imaging and tabular data for improved survival prediction.

Sambit Tarai, Ashish Chauhan, Elin Lundström +5

Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, SE-75185, Sweden · Molecular Imaging and Medical Physics, Department of Surgical Sciences, Uppsala University, Uppsala, SE-75185, Sweden · Antaros Medical, Mölndal, SE-43153, Sweden

Cancer Survival Prediction Survival Analysis Multimodal Survival Analysis

Apr 5, 2026

Good Rankings, Wrong Probabilities: A Calibration Audit of Multimodal Cancer Survival Models

Multimodal deep learning models that fuse whole-slide histopathology images with genomic data have achieved strong discriminative performance for cancer survival prediction, as measured by the concordance index. Yet whether the survival probabilities derived from these models - either directly from native outputs or via standard post-hoc reconstruction - are calibrated remains largely unexamined. We conduct, to our knowledge, the first systematic fold-level 1-calibration audit of multimodal WSI-genomics survival architectures, evaluating native discrete-time survival outputs (Experiment A: 3 models on TCGA-BRCA) and Breslow-reconstructed survival curves from scalar risk scores (Experiment B: 11 architectures across 5 TCGA cancer types). In Experiment A, all three models fail 1-calibration on a majority of folds (12 of 15 fold-level tests reject after Benjamini-Hochberg correction). Across the full 290 fold-level tests, 166 reject the null of correct calibration at the median event time after Benjamini-Hochberg correction (FDR = 0.05). MCAT achieves C-index 0.817 on GBMLGG yet fails 1-calibration on all five folds. Gating-based fusion is associated with better calibration; bilinear and concatenation fusion are not. Post-hoc Platt scaling reduces miscalibration at the evaluated horizon (e.g., MCAT: 5/5 folds failing to 2/5) without affecting discrimination. The concordance index alone is insufficient for evaluating survival models intended for clinical use.

Sajad Ghawami

Independent Researcher

Cancer Survival Prediction Multimodal Survival Analysis Survival Analysis Post-Hoc Calibration Multimodal Fusion

Apr 3, 2026

Nonparametric Regression Discontinuity Designs with Survival Outcomes

Quasi-experimental evaluations are central for generating real-world causal evidence and complementing insights from randomized trials. The regression discontinuity design (RDD) is a quasi-experimental design that can be used to estimate the causal effect of treatments that are assigned based on a running variable crossing a threshold. Such threshold-based rules are ubiquitous in healthcare, where predictive and prognostic biomarkers frequently guide treatment decisions. However, standard RD estimators rely on complete outcome data, an assumption often violated in time-to-event analyses where censoring arises from loss to follow-up. To address this issue, we propose a nonparametric approach that leverages doubly robust censoring corrections and can be paired with existing RD estimators. Our approach can handle multiple survival endpoints, long follow-up times, and covariate-dependent variation in survival and censoring. We discuss the relevance of our approach across multiple areas of applications and demonstrate its usefulness through simulations and the prostate component of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial where our new approach offers several advantages, including higher efficiency and robustness to misspecification. We have also developed an open-source software package,

\texttt{rdsurvival}

, for the

\texttt{R}

language.

Maximilian Schuessler, Erik Sverdrup, Robert Tibshirani +1

Causal Effect Estimation Survival Analysis Nonparametric Regression

Mar 31, 2026

Survival In-Context: Amortized Bayesian Survival Analysis via Prior-Fitted Networks

Survival analysis is crucial for many medical applications, but remains challenging for modern machine learning due to limited data, censoring, and the heterogeneity of tabular covariates. While the prior-fitted paradigm, which relies on pretraining models on large collections of synthetic datasets, has recently facilitated tabular foundation models for classification and regression, its suitability for time-to-event modeling remains unclear. We propose a flexible survival data generation framework that defines a rich survival prior with explicit control over covariates and time-event distributions. Building on this prior, we introduce Survival In-Context (SIC), a prior-fitted in-context learning model for survival analysis that is pretrained exclusively on synthetic data. SIC is trained to approximate Bayesian posterior predictive inference under the synthetic survival prior, enabling individualized survival prediction in a single forward pass, requiring no task-specific training or hyperparameter tuning. Across a broad evaluation on real-world survival datasets, SIC achieves competitive or superior performance compared to classical and deep survival models, particularly in small and medium-sized data regimes, highlighting the promise of a prior-fitted paradigm for survival analysis. The code and pretrained models will be made available upon publication.

Dmitrii Seletkov, Paul Hager, Georgios Kaissis +3

Institute of Diagnostic and Interventional Radiology, Technical University of Munich, Germany · Chair for AI in Healthcare and Medicine, Technical University of Munich, Germany · Hasso Plattner Institute for Digital Engineering, University of Potsdam, Germany +3

Survival Analysis Prior-Data Fitted Networks In-Context Learning Amortized Inference Synthetic Data Pretraining