SCMIL: Sparse Context-aware Multiple Instance Learning for Predicting Cancer Survival Probability Distribution in Whole Slide Images

Cancer survival prediction is a challenging task that involves analyzing of the tumor microenvironment within Whole Slide Image (WSI). Previous methods cannot effectively capture the intricate interaction features among instances within the local area of WSI. Moreover, existing methods for cancer survival prediction based on WSI often fail to provide better clinically meaningful predictions. To overcome these challenges, we propose a Sparse Context-aware Multiple Instance Learning (SCMIL) framework for predicting cancer survival probability distributions. SCMIL innovatively segments patches into various clusters based on their morphological features and spatial location information, subsequently leveraging sparse self-attention to discern the relationships between these patches with a context-aware perspective. Considering many patches are irrelevant to the task, we introduce a learnable patch filtering module called SoftFilter, which ensures that only interactions between task-relevant patches are considered. To enhance the clinical relevance of our prediction, we propose a register-based mixture density network to forecast the survival probability distribution for individual patients. We evaluate SCMIL on two public WSI datasets from the The Cancer Genome Atlas (TCGA) specifically focusing on lung adenocarcinom (LUAD) and kidney renal clear cell carcinoma (KIRC). Our experimental results indicate that SCMIL outperforms current state-of-the-art methods for survival prediction, offering more clinically meaningful and interpretable outcomes. Our code is accessible at https://github.com/yang-ze-kang/SCMIL.