Multimodal Optimal Transport-based Co-Attention Transformer with Global Structure Consistency for Survival Prediction
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Abstract (arXiv)
Survival prediction is a complicated ordinal regression task that aims to predict the ranking risk of death, which generally benefits from the integration of histology and genomic data. Despite the progress in joint learning from pathology and genomics, existing methods still suffer from challenging issues: 1) Due to the large size of pathological images, it is difficult to effectively represent the gigapixel whole slide images (WSIs). 2) Interactions within tumor microenvironment (TME) in histology are essential for survival analysis. Although current approaches attempt to model these interactions via co-attention between histology and genomic data, they focus on only dense local similarity across modalities, which fails to capture global consistency between potential structures, i.e. TME-related interactions of histology and co-expression of genomic data. To address these challenges, we propose a Multimodal Optimal Transport-based Co-Attention Transformer framework with global structure consistency, in which optimal transport (OT) is applied to match patches of a WSI and genes embeddings for selecting informative patches to represent the gigapixel WSI. More importantly, OT-based co-attention provides a global awareness to effectively capture structural interactions within TME for survival prediction. To overcome high computational complexity of OT, we propose a robust and efficient implementation over micro-batch of WSI patches by approximating the original OT with unbalanced mini-batch OT. Extensive experiments show the superiority of our method on five benchmark datasets compared to the state-of-the-art methods. The code is released.
Key facts. Cited by 86 papers in the map (data through 14 Oct 2026). Builds on 17 of its 60 references that are in the map. First posted on arXiv 14 Jun 2023.
Builds on
17 of 60 references.
References · 17
- 2016Identity Mappings in Deep Residual Networkscited by 1,965
- 2018Attention-based Deep Multiple Instance Learningcited by 1,095
- 2020Data Efficient and Weakly Supervised Computational Pathology on Whole Slide Imagescited by 745
- 2017Self-Normalizing Neural Networkscited by 598
- 2021TransMIL: Transformer based Correlated Multiple Instance Learning for Whole Slide Image Classificationcited by 555
- 2020Dual-stream Multiple Instance Learning Network for Whole Slide Image Classification with Self-supervised Contrastive Learningcited by 478
- 2022DTFD-MIL: Double-Tier Feature Distillation Multiple Instance Learning for Histopathology Whole Slide Image Classificationcited by 256
- 2015Learning with a Wasserstein Losscited by 196
- 2020Whole Slide Images based Cancer Survival Prediction using Attention Guided Deep Multiple Instance Learning Networkscited by 178
- 2019Pathomic Fusion: An Integrated Framework for Fusing Histopathology and Genomic Features for Cancer Diagnosis and Prognosiscited by 165
- 2021Unbalanced minibatch Optimal Transport; applications to Domain Adaptationcited by 125
- 2020Multi-scale Domain-adversarial Multiple-instance CNN for Cancer Subtype Classification with Unannotated Histopathological Imagescited by 81
5 more
- 2019CAMEL: A Weakly Supervised Learning Framework for Histopathology Image Segmentationcited by 73
- 2021Cluster-to-Conquer: A Framework for End-to-End Multi-Instance Learning for Whole Slide Image Classificationcited by 65
- 2022Multi-modal Alignment using Representation Codebookcited by 63
- 2018Co-Learning Feature Fusion Maps from PET-CT Images of Lung Cancercited by 14
- 2023Deep Biological Pathway Informed Pathology-Genomic Multimodal Survival Predictioncited by 5
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Citing papers per year: 2023: 2; 2024: 21; 2025: 40; 2026: 23.
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- 2024Morphological Prototyping for Unsupervised Slide Representation Learning in Computational Pathologycited by 72
- 2024A Multimodal Knowledge-enhanced Whole-slide Pathology Foundation Modelcited by 59
- 2024Transcriptomics-guided Slide Representation Learning in Computational Pathologycited by 51
- 2024Multimodal Prototyping for cancer survival predictioncited by 47
- 2024Prototypical Information Bottlenecking and Disentangling for Multimodal Cancer Survival Predictioncited by 41
- 2023HEALNet: Multimodal Fusion for Heterogeneous Biomedical Datacited by 25
- 2024MoME: Mixture of Multimodal Experts for Cancer Survival Predictioncited by 23
- 2024FOCUS: Knowledge-enhanced Adaptive Visual Compression for Few-shot Whole Slide Image Classificationcited by 20
- 2024Self-eXplainable AI for Medical Image Analysis: A Survey and New Outlookscited by 18
- 2024PathM3: A Multimodal Multi-Task Multiple Instance Learning Framework for Whole Slide Image Classification and Captioningcited by 14
- 2024Cohort-Individual Cooperative Learning for Multimodal Cancer Survival Analysiscited by 13
- 2025Robust Multimodal Survival Prediction with the Latent Differentiation Conditional Variational AutoEncodercited by 13
38 more
- 2025Distilled Prompt Learning for Incomplete Multimodal Survival Predictioncited by 11
- 2025Multimodal Cancer Survival Analysis via Hypergraph Learning with Cross-Modality Rebalancecited by 11
- 2024Multimodal Data Integration for Precision Oncology: Challenges and Future Directionscited by 10
- 2025ESPFormer: Doubly-Stochastic Attention with Expected Sliced Transport Planscited by 10
- 2023MGCT: Mutual-Guided Cross-Modality Transformer for Survival Outcome Prediction using Integrative Histopathology-Genomic Featurescited by 8
- 2024SurvMamba: State Space Model with Multi-grained Multi-modal Interaction for Survival Predictioncited by 7
- 2024GTP-4o: Modality-prompted Heterogeneous Graph Learning for Omni-modal Biomedical Representationcited by 7
- 2024Histo-Genomic Knowledge Distillation For Cancer Prognosis From Histopathology Whole Slide Imagescited by 6
- 2024HoneyBee: A Scalable Modular Framework for Creating Multimodal Oncology Datasets with Foundational Embedding Modelscited by 6
- 2025HASD: Hierarchical Adaption for pathology Slide-level Domain-shiftcited by 6
- 2025DPsurv: Dual-Prototype Evidential Fusion for Uncertainty-Aware and Interpretable Whole-Slide Image Survival Predictioncited by 6
- 2025SurvAgent: Hierarchical CoT-Enhanced Case Banking and Dichotomy-Based Multi-Agent System for Multimodal Survival Predictioncited by 5
- 2026Act Like a Pathologist: Tissue-Aware Whole Slide Image Reasoningcited by 5
- 2024RankByGene: Gene-Guided Histopathology Representation Learning Through Cross-Modal Ranking Consistencycited by 4
- 2025Disentangled and Interpretable Multimodal Attention Fusion for Cancer Survival Predictioncited by 4
- 2025Memory-Augmented Incomplete Multimodal Survival Prediction via Cross-Slide and Gene-Attentive Hypergraph Learningcited by 4
- 2026Momentum Memory for Knowledge Distillation in Computational Pathologycited by 4
- 2025Prototype-Guided Cross-Modal Knowledge Enhancement for Adaptive Survival Predictioncited by 3
- 2025AdaMHF: Adaptive Multimodal Hierarchical Fusion for Survival Predictioncited by 3
- 2025MurreNet: Modeling Holistic Multimodal Interactions Between Histopathology and Genomic Profiles for Survival Predictioncited by 3
- 2025PTCMIL: Multiple Instance Learning via Prompt Token Clustering for Whole Slide Image Analysiscited by 3
- 2025PS3: A Multimodal Transformer Integrating Pathology Reports with Histology Images and Biological Pathways for Cancer Survival Predictioncited by 3
- 2025GenAR: Next-Scale Autoregressive Generation for Spatial Gene Expression Predictioncited by 3
- 2024Leveraging Intra-modal and Inter-modal Interaction for Multi-Modal Entity Alignmentcited by 2
- 2024Multimodal Lego: Model Merging and Fine-Tuning Across Topologies and Modalities in Biomedicinecited by 2
- 2025Adaptive Prototype Learning for Multimodal Cancer Survival Analysiscited by 2
- 2025HySurvPred: Multimodal Hyperbolic Embedding with Angle-Aware Hierarchical Contrastive Learning and Uncertainty Constraints for Survival Predictioncited by 2
- 2025ModalTune: Fine-Tuning Slide-Level Foundation Models with Multi-Modal Information for Multi-task Learning in Digital Pathologycited by 2
- 2025CoC: Chain-of-Cancer based on Cross-Modal Autoregressive Traction for Survival Predictioncited by 2
- 2025HiLa: Hierarchical Vision-Language Collaboration for Cancer Survival Predictioncited by 2
- 2025Disentangled Multi-modal Learning of Histology and Transcriptomics for Cancer Characterizationcited by 2
- 2025Multi-modal Knowledge Decomposition based Online Distillation for Biomarker Prediction in Breast Cancer Histopathologycited by 2
- 2025A Multimodal Foundation Model to Enhance Generalizability and Data Efficiency for Pan-cancer Prognosis Predictioncited by 2
- 2025ME-Mamba: Multi-Expert Mamba with Efficient Knowledge Capture and Fusion for Multimodal Survival Analysiscited by 2
- 2025PEaRL: Pathway-Enhanced Representation Learning for Gene and Pathway Expression Prediction from Histologycited by 2
- 2025Libra-MIL: Multimodal Prototypes Stereoscopic Infused with Task-specific Language Priors for Few-shot Whole Slide Image Classificationcited by 2
- 2025ConSurv: Multimodal Continual Learning for Survival Analysiscited by 2
- 2024NYK-MS: A Well-annotated Multi-modal Metaphor and Sarcasm Understanding Benchmark on Cartoon-Caption Datasetcited by 1
50 most cited of 86 All 86 (JSON)
- 2026Multi-Modal Anomaly Detection: A Survey24 Aug 2026
- 2026CACSurv: Concordance-Aligned Comparative Learning with Large Language Models for Cancer Survival Prediction17 Aug 2026
- 2026CIGTSurv: Clinical Information Guided Tri-modal Survival Prediction with Local Prototype Association and Global Feature Alignment4 Aug 2026
- 2026Advancing Multimodal Fusion on Heterogeneous Medical Data with Hybrid Geometry Attention21 Jul 2026
- 2026Weakly Supervised Pathology-Informed Representation Learning for PET-Based Content Retrieval of Intra-Tumour Heterogeneity21 Jul 2026
- 2026Cross-Modal Iteration Distillation for Robust IHD Screening: The IDNet Framework and A New Benchmark29 Jun 2026
- 2026AdaSurvMamba: Dynamic Fusion and Semantic Scanning for Multimodal Survival Analysis28 Jun 2026
- 2026HERO: Hypothesis-Driven Evidence Retrieval from Omics for Multi-Task Breast Cancer Analysis19 Jun 2026
- 2026Evidential Fusion Network for Multimodal Survival Prediction under Missing Modalities18 Jun 2026
- 2026Semantic-Anchored Evidential Fusion for Domain-Robust Whole-Slide Survival Analysis18 Jun 2026
- 2026RePercENT: Scaling Disentangled Representation Learning Beyond Two Modalities3 Jun 2026
- 2026Pathway-Structured Privileged Distillation for Deployable Computational Pathology1 Jun 2026
38 more
- 2026ProtoPathway: Biologically Structured Prototype-Pathway Fusion for Multimodal Cancer Survival Prediction20 May 2026
- 2026Medical Image Understanding Improves Survival Prediction via Visual Instruction Tuning20 Apr 2026
- 2026Good Rankings, Wrong Probabilities: A Calibration Audit of Multimodal Cancer Survival Models5 Apr 2026
- 2026MUST: Modality-Specific Representation-Aware Transformer for Diffusion-Enhanced Survival Prediction with Missing Modality27 Mar 2026
- 2026HGP-Mamba: Integrating Histology and Generated Protein Features for Mamba-based Multimodal Survival Risk Prediction17 Mar 2026
- 2026Advancing Cancer Prognosis with Hierarchical Fusion of Genomic, Proteomic and Pathology Imaging Data from a Systems Biology Perspective14 Mar 2026
- 2026Bridging the gap between Performance and Interpretability: An Explainable Disentangled Multimodal Framework for Cancer Survival Prediction2 Mar 2026
- 2026Act Like a Pathologist: Tissue-Aware Whole Slide Image Reasoning28 Feb 2026
- 2026Momentum Memory for Knowledge Distillation in Computational Pathology24 Feb 2026
- 2026Prototype-driven fusion of pathology and spatial transcriptomics for interpretable survival prediction12 Feb 2026
- 2026Tissue Classification and Whole-Slide Images Analysis via Modeling of the Tumor Microenvironment and Biological Pathways13 Jan 2026
- 2025LLM-driven Knowledge Enhancement for Multimodal Cancer Survival Prediction16 Dec 2025
- 2025Structural Prognostic Event Modeling for Multimodal Cancer Survival Analysis30 Nov 2025
- 2025Together, Then Apart: Balancing Alignment and Distinctiveness for Multimodal Survival Analysis22 Nov 2025
- 2025SurvAgent: Hierarchical CoT-Enhanced Case Banking and Dichotomy-Based Multi-Agent System for Multimodal Survival Prediction20 Nov 2025
- 2025ConSurv: Multimodal Continual Learning for Survival Analysis13 Nov 2025
- 2025Libra-MIL: Multimodal Prototypes Stereoscopic Infused with Task-specific Language Priors for Few-shot Whole Slide Image Classification11 Nov 2025
- 2025A Flow Model with Low-Rank Transformers for Incomplete Multimodal Survival Analysis22 Oct 2025
- 2025Multimodal Feature Prototype Learning for Interpretable and Discriminative Cancer Survival Prediction7 Oct 2025
- 2025GenAR: Next-Scale Autoregressive Generation for Spatial Gene Expression Prediction5 Oct 2025
- 2025PEaRL: Pathway-Enhanced Representation Learning for Gene and Pathway Expression Prediction from Histology3 Oct 2025
- 2025DPsurv: Dual-Prototype Evidential Fusion for Uncertainty-Aware and Interpretable Whole-Slide Image Survival Prediction28 Sep 2025
- 2025PS3: A Multimodal Transformer Integrating Pathology Reports with Histology Images and Biological Pathways for Cancer Survival Prediction24 Sep 2025
- 2025ME-Mamba: Multi-Expert Mamba with Efficient Knowledge Capture and Fusion for Multimodal Survival Analysis21 Sep 2025
- 2025A Multimodal Foundation Model to Enhance Generalizability and Data Efficiency for Pan-cancer Prognosis Prediction16 Sep 2025
- 2025Multi-modal Knowledge Decomposition based Online Distillation for Biomarker Prediction in Breast Cancer Histopathology24 Aug 2025
- 2025Disentangled Multi-modal Learning of Histology and Transcriptomics for Cancer Characterization22 Aug 2025
- 2025Learning local and global prototypes with optimal transport for unsupervised anomaly detection and localization18 Aug 2025
- 2025Masked Omics Modeling for Multimodal Representation Learning across Histopathology and Molecular Profiles1 Aug 2025
- 2025PTCMIL: Multiple Instance Learning via Prompt Token Clustering for Whole Slide Image Analysis24 Jul 2025
- 2025Robust Incomplete-Modality Alignment for Ophthalmic Disease Grading and Diagnosis via Labeled Optimal Transport7 Jul 2025
- 2025MurreNet: Modeling Holistic Multimodal Interactions Between Histopathology and Genomic Profiles for Survival Prediction7 Jul 2025
- 2025HiLa: Hierarchical Vision-Language Collaboration for Cancer Survival Prediction7 Jul 2025
- 2025HASD: Hierarchical Adaption for pathology Slide-level Domain-shift30 Jun 2025
- 2025Genome-Anchored Foundation Model Embeddings Improve Molecular Prediction from Histology Images24 Jun 2025
- 2025Memory-Augmented Incomplete Multimodal Survival Prediction via Cross-Slide and Gene-Attentive Hypergraph Learning24 Jun 2025
- 2025CoC: Chain-of-Cancer based on Cross-Modal Autoregressive Traction for Survival Prediction28 May 2025
- 2025Any-to-Any Learning in Computational Pathology via Triplet Multimodal Pretraining19 May 2025
50 newest of 86 All 86 (JSON)
- 2024SurvMamba: State Space Model with Multi-grained Multi-modal Interaction for Survival Predictioncited by 7
- 2025ME-Mamba: Multi-Expert Mamba with Efficient Knowledge Capture and Fusion for Multimodal Survival Analysiscited by 2
- 2026HGP-Mamba: Integrating Histology and Generated Protein Features for Mamba-based Multimodal Survival Risk Predictioncited by 0
- 2026AdaSurvMamba: Dynamic Fusion and Semantic Scanning for Multimodal Survival Analysiscited by 0
- 2026AdaSurvMamba: Dynamic Fusion and Semantic Scanning for Multimodal Survival Analysis28 Jun 2026
- 2026HGP-Mamba: Integrating Histology and Generated Protein Features for Mamba-based Multimodal Survival Risk Prediction17 Mar 2026
- 2025ME-Mamba: Multi-Expert Mamba with Efficient Knowledge Capture and Fusion for Multimodal Survival Analysis21 Sep 2025
- 2024SurvMamba: State Space Model with Multi-grained Multi-modal Interaction for Survival Prediction11 Apr 2024
- 2025ConSurv: Multimodal Continual Learning for Survival Analysis13 Nov 2025
- 2024Morphological Prototyping for Unsupervised Slide Representation Learning in Computational Pathologycited by 72
- 2024A Multimodal Knowledge-enhanced Whole-slide Pathology Foundation Modelcited by 59
- 2024Transcriptomics-guided Slide Representation Learning in Computational Pathologycited by 51
- 2024Multimodal Prototyping for cancer survival predictioncited by 47
- 2024Prototypical Information Bottlenecking and Disentangling for Multimodal Cancer Survival Predictioncited by 41
- 2023HEALNet: Multimodal Fusion for Heterogeneous Biomedical Datacited by 25
- 2024MoME: Mixture of Multimodal Experts for Cancer Survival Predictioncited by 23
- 2024FOCUS: Knowledge-enhanced Adaptive Visual Compression for Few-shot Whole Slide Image Classificationcited by 20
- 2024Self-eXplainable AI for Medical Image Analysis: A Survey and New Outlookscited by 18
- 2024PathM3: A Multimodal Multi-Task Multiple Instance Learning Framework for Whole Slide Image Classification and Captioningcited by 14
- 2024Cohort-Individual Cooperative Learning for Multimodal Cancer Survival Analysiscited by 13
- 2025Robust Multimodal Survival Prediction with the Latent Differentiation Conditional Variational AutoEncodercited by 13
12 most cited of 77 All 77 (JSON)
- 2026Multi-Modal Anomaly Detection: A Survey24 Aug 2026
- 2026CACSurv: Concordance-Aligned Comparative Learning with Large Language Models for Cancer Survival Prediction17 Aug 2026
- 2026CIGTSurv: Clinical Information Guided Tri-modal Survival Prediction with Local Prototype Association and Global Feature Alignment4 Aug 2026
- 2026Advancing Multimodal Fusion on Heterogeneous Medical Data with Hybrid Geometry Attention21 Jul 2026
- 2026Weakly Supervised Pathology-Informed Representation Learning for PET-Based Content Retrieval of Intra-Tumour Heterogeneity21 Jul 2026
- 2026Cross-Modal Iteration Distillation for Robust IHD Screening: The IDNet Framework and A New Benchmark29 Jun 2026
- 2026HERO: Hypothesis-Driven Evidence Retrieval from Omics for Multi-Task Breast Cancer Analysis19 Jun 2026
- 2026Evidential Fusion Network for Multimodal Survival Prediction under Missing Modalities18 Jun 2026
- 2026Semantic-Anchored Evidential Fusion for Domain-Robust Whole-Slide Survival Analysis18 Jun 2026
- 2026RePercENT: Scaling Disentangled Representation Learning Beyond Two Modalities3 Jun 2026
- 2026Pathway-Structured Privileged Distillation for Deployable Computational Pathology1 Jun 2026
- 2026ProtoPathway: Biologically Structured Prototype-Pathway Fusion for Multimodal Cancer Survival Prediction20 May 2026
12 newest of 77 All 77 (JSON)