# Trimodal Deep Learning for Glioma Survival Prediction: A Feasibility Study Integrating Histopathology, Gene Expression, and MRI

arXiv: https://arxiv.org/abs/2603.29968 · HTML: https://mlsanity.com/paper/2603.29968/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 6 of its 20 references that are in the map.
- First posted on arXiv 31 Mar 2026.

## Builds on (most cited first, 6 of 6)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [DeepSurv: Personalized Treatment Recommender System Using A Cox Proportional Hazards Deep Neural Network](https://mlsanity.com/paper/1606.00931/) (2016)
- [Med3D: Transfer Learning for 3D Medical Image Analysis](https://mlsanity.com/paper/1904.00625/) (2019)
- [Pathomic Fusion: An Integrated Framework for Fusing Histopathology and Genomic Features for Cancer Diagnosis and Prognosis](https://mlsanity.com/paper/1912.08937/) (2019)
- [Models Genesis: Generic Autodidactic Models for 3D Medical Image Analysis](https://mlsanity.com/paper/1908.06912/) (2019)
- [Modeling Dense Multimodal Interactions Between Biological Pathways and Histology for Survival Prediction](https://mlsanity.com/paper/2304.06819/) (2023)

## Abstract (arXiv)

Multimodal deep learning has improved prognostic accuracy for brain tumours by integrating histopathology and genomic data, yet the contribution of volumetric MRI within unified survival frameworks remains unexplored. This pilot study extends a bimodal framework by incorporating Fluid Attenuated Inversion Recovery (FLAIR) MRI from BraTS2021 as a third modality. Using the TCGA-GBMLGG cohort (664 patients), we evaluate three unimodal models, nine bimodal configurations, and three trimodal configurations across early, late, and joint fusion strategies. In this small cohort setting, trimodal early fusion achieves an exploratory Composite Score (CS = 0.854), with a controlled DeltaCS of +0.011 over the bimodal baseline on identical patients, though this difference is not statistically significant (p = 0.250, permutation test). MRI achieves reasonable unimodal discrimination (CS = 0.755) but does not substantially improve bimodal pairs, while providing measurable uplift in the three-way combination. All MRI containing experiments are constrained to 19 test patients, yielding wide bootstrap confidence intervals (e.g. [0.400,1.000]) that preclude definitive conclusions. These findings provide preliminary evidence that a third imaging modality may add prognostic value even with limited sample sizes, and that additional modalities require sufficient multimodal context to contribute effectively.