# Together, Then Apart: Balancing Alignment and Distinctiveness for Multimodal Survival Analysis

arXiv: https://arxiv.org/abs/2511.18089 · HTML: https://mlsanity.com/paper/2511.18089/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 29 of its 51 references that are in the map.
- First posted on arXiv 22 Nov 2025.

## Builds on (most cited first, 29 of 29)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Representation Learning with Contrastive Predictive Coding](https://mlsanity.com/paper/1807.03748/) (2018)
- [Sinkhorn Distances: Lightspeed Computation of Optimal Transportation Distances](https://mlsanity.com/paper/1306.0895/) (2013)
- [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)
- [Self-Normalizing Neural Networks](https://mlsanity.com/paper/1706.02515/) (2017)
- [Dual-stream Multiple Instance Learning Network for Whole Slide Image Classification with Self-supervised Contrastive Learning](https://mlsanity.com/paper/2011.08939/) (2020)
- [Scaling Vision Transformers to Gigapixel Images via Hierarchical Self-Supervised Learning](https://mlsanity.com/paper/2206.02647/) (2022)
- [DTFD-MIL: Double-Tier Feature Distillation Multiple Instance Learning for Histopathology Whole Slide Image Classification](https://mlsanity.com/paper/2203.12081/) (2022)
- [Whole Slide Images based Cancer Survival Prediction using Attention Guided Deep Multiple Instance Learning Networks](https://mlsanity.com/paper/2009.11169/) (2020)
- [Pathomic Fusion: An Integrated Framework for Fusing Histopathology and Genomic Features for Cancer Diagnosis and Prognosis](https://mlsanity.com/paper/1912.08937/) (2019)
- [Whole Slide Images are 2D Point Clouds: Context-Aware Survival Prediction using Patch-based Graph Convolutional Networks](https://mlsanity.com/paper/2107.13048/) (2021)
- [Graph Optimal Transport for Cross-Domain Alignment](https://mlsanity.com/paper/2006.14744/) (2020)
- [Modeling Dense Multimodal Interactions Between Biological Pathways and Histology for Survival Prediction](https://mlsanity.com/paper/2304.06819/) (2023)
- [Interventional Bag Multi-Instance Learning On Whole-Slide Pathological Images](https://mlsanity.com/paper/2303.06873/) (2023)
- [MambaMIL: Enhancing Long Sequence Modeling with Sequence Reordering in Computational Pathology](https://mlsanity.com/paper/2403.06800/) (2024)
- [Multimodal Optimal Transport-based Co-Attention Transformer with Global Structure Consistency for Survival Prediction](https://mlsanity.com/paper/2306.08330/) (2023)
- [Morphological Prototyping for Unsupervised Slide Representation Learning in Computational Pathology](https://mlsanity.com/paper/2405.11643/) (2024)
- [Cross-Modal Translation and Alignment for Survival Analysis](https://mlsanity.com/paper/2309.12855/) (2023)
- [Multimodal Prototyping for cancer survival prediction](https://mlsanity.com/paper/2407.00224/) (2024)
- [Pathology-and-genomics Multimodal Transformer for Survival Outcome Prediction](https://mlsanity.com/paper/2307.11952/) (2023)
- [Calibrating Multi-modal Representations: A Pursuit of Group Robustness without Annotations](https://mlsanity.com/paper/2403.07241/) (2024)
- [Beyond Matryoshka: Revisiting Sparse Coding for Adaptive Representation](https://mlsanity.com/paper/2503.01776/) (2025)
- [Uncovering Memorization Effect in the Presence of Spurious Correlations](https://mlsanity.com/paper/2501.00961/) (2025)
- [HVTSurv: Hierarchical Vision Transformer for Patient-Level Survival Prediction from Whole Slide Image](https://mlsanity.com/paper/2306.17373/) (2023)
- [P2OT: Progressive Partial Optimal Transport for Deep Imbalanced Clustering](https://mlsanity.com/paper/2401.09266/) (2024)
- [Distilled Prompt Learning for Incomplete Multimodal Survival Prediction](https://mlsanity.com/paper/2503.01653/) (2025)
- [Multimodal Cancer Survival Analysis via Hypergraph Learning with Cross-Modality Rebalance](https://mlsanity.com/paper/2505.11997/) (2025)
- [OTSurv: A Novel Multiple Instance Learning Framework for Survival Prediction with Heterogeneity-aware Optimal Transport](https://mlsanity.com/paper/2506.20741/) (2025)

## Built on by (most cited first, 1 of 1)

- [Scale Where It Matters: Training-Free Localized Scaling for Diffusion Models](https://mlsanity.com/paper/2511.19917/) (2025)

## Abstract (arXiv)

Multimodal survival analysis aims to improve cancer prognosis using heterogeneous biomedical data, such as histopathology images and genomic profiles. A common strategy is to align representations across modalities so that shared signals can be captured. However, strong cross-modal alignment can also remove modality-specific evidence that is critical for survival prediction. In this paper, we revisit multimodal survival learning from a simple observation: effective models should first discover shared patterns across modalities, and then preserve modality-specific signals. This motivates a representation learning principle that we refer to as Together Then Apart. Based on this idea, we propose TTA, a framework that balances cross-modal alignment and representation distinctiveness. TTA first performs prototype-based alignment to capture shared survival-related structures between modalities. It then encourages modality-specific distinctiveness through an anchor-guided contrastive objective. To further account for modality imbalance and noisy correspondences, we model cross-modal interactions using unbalanced optimal transport. We evaluate the proposed approach on multiple TCGA cancer cohorts with paired histopathology and genomic data. TTA consistently improves survival prediction over recent multimodal survival models. Moreover, the learned prototype structures reveal interpretable cross-modal patterns associated with clinical outcomes.