# MIL vs. Aggregation: Evaluating Patient-Level Survival Prediction Strategies Using Graph-Based Learning

arXiv: https://arxiv.org/abs/2503.23042 · HTML: https://mlsanity.com/paper/2503.23042/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 20 references that are in the map.
- First posted on arXiv 29 Mar 2025.

## Builds on (most cited first, 12 of 12)

- [Semi-Supervised Classification with Graph Convolutional Networks](https://mlsanity.com/paper/1609.02907/) (2016)
- [Graph Attention Networks](https://mlsanity.com/paper/1710.10903/) (2017)
- [Inductive Representation Learning on Large Graphs](https://mlsanity.com/paper/1706.02216/) (2017)
- [Attention-based Deep Multiple Instance Learning](https://mlsanity.com/paper/1802.04712/) (2018)
- [Data Efficient and Weakly Supervised Computational Pathology on Whole Slide Images](https://mlsanity.com/paper/2004.09666/) (2020)
- [Dual-stream Multiple Instance Learning Network for Whole Slide Image Classification with Self-supervised Contrastive Learning](https://mlsanity.com/paper/2011.08939/) (2020)
- [Whole Slide Images are 2D Point Clouds: Context-Aware Survival Prediction using Patch-based Graph Convolutional Networks](https://mlsanity.com/paper/2107.13048/) (2021)
- [CGC-Net: Cell Graph Convolutional Network for Grading of Colorectal Cancer Histology Images](https://mlsanity.com/paper/1909.01068/) (2019)
- [Learning Whole-Slide Segmentation from Inexact and Incomplete Labels using Tissue Graphs](https://mlsanity.com/paper/2103.03129/) (2021)
- [Gigapixel Whole-Slide Images Classification using Locally Supervised Learning](https://mlsanity.com/paper/2207.08267/) (2022)
- [MMIST-ccRCC: A Real World Medical Dataset for the Development of Multi-Modal Systems](https://mlsanity.com/paper/2405.01658/) (2024)
- [The Role of Graph-based MIL and Interventional Training in the Generalization of WSI Classifiers](https://mlsanity.com/paper/2501.19048/) (2025)

## Abstract (arXiv)

Oncologists often rely on a multitude of data, including whole-slide images (WSIs), to guide therapeutic decisions, aiming for the best patient outcome. However, predicting the prognosis of cancer patients can be a challenging task due to tumor heterogeneity and intra-patient variability, and the complexity of analyzing WSIs. These images are extremely large, containing billions of pixels, making direct processing computationally expensive and requiring specialized methods to extract relevant information. Additionally, multiple WSIs from the same patient may capture different tumor regions, some being more informative than others. This raises a fundamental question: Should we use all WSIs to characterize the patient, or should we identify the most representative slide for prognosis? Our work seeks to answer this question by performing a comparison of various strategies for predicting survival at the WSI and patient level. The former treats each WSI as an independent sample, mimicking the strategy adopted in other works, while the latter comprises methods to either aggregate the predictions of the several WSIs or automatically identify the most relevant slide using multiple-instance learning (MIL). Additionally, we evaluate different Graph Neural Networks architectures under these strategies. We conduct our experiments using the MMIST-ccRCC dataset, which comprises patients with clear cell renal cell carcinoma (ccRCC). Our results show that MIL-based selection improves accuracy, suggesting that choosing the most representative slide benefits survival prediction.