# ChronoSurv: A Clinical Pathway-Guided Graph Framework for Multimodal Survival Analysis

arXiv: https://arxiv.org/abs/2606.19140 · HTML: https://mlsanity.com/paper/2606.19140/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 16 of its 39 references that are in the map.
- First posted on arXiv 17 Jun 2026.

## Builds on (most cited first, 16 of 16)

- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [Publicly Available Clinical BERT Embeddings](https://mlsanity.com/paper/1904.03323/) (2019)
- [How Attentive are Graph Attention Networks?](https://mlsanity.com/paper/2105.14491/) (2021)
- [DeepSurv: Personalized Treatment Recommender System Using A Cox Proportional Hazards Deep Neural Network](https://mlsanity.com/paper/1606.00931/) (2016)
- [Whole Slide Images are 2D Point Clouds: Context-Aware Survival Prediction using Patch-based Graph Convolutional Networks](https://mlsanity.com/paper/2107.13048/) (2021)
- [Modeling Dense Multimodal Interactions Between Biological Pathways and Histology for Survival Prediction](https://mlsanity.com/paper/2304.06819/) (2023)
- [Effective Ways to Build and Evaluate Individual Survival Distributions](https://mlsanity.com/paper/1811.11347/) (2018)
- [CGC-Net: Cell Graph Convolutional Network for Grading of Colorectal Cancer Histology Images](https://mlsanity.com/paper/1909.01068/) (2019)
- [SlideGraph+: Whole Slide Image Level Graphs to Predict HER2Status in Breast Cancer](https://mlsanity.com/paper/2110.06042/) (2021)
- [X-CAL: Explicit Calibration for Survival Analysis](https://mlsanity.com/paper/2101.05346/) (2021)
- [Survival Prediction of Brain Cancer with Incomplete Radiology, Pathology, Genomics, and Demographic Data](https://mlsanity.com/paper/2203.04419/) (2022)
- [MoME: Mixture of Multimodal Experts for Cancer Survival Prediction](https://mlsanity.com/paper/2406.09696/) (2024)
- [Multimodal Cancer Survival Analysis via Hypergraph Learning with Cross-Modality Rebalance](https://mlsanity.com/paper/2505.11997/) (2025)
- [SurvRNC: Learning Ordered Representations for Survival Prediction using Rank-N-Contrast](https://mlsanity.com/paper/2403.10603/) (2024)
- [Merging-Diverging Hybrid Transformer Networks for Survival Prediction in Head and Neck Cancer](https://mlsanity.com/paper/2307.03427/) (2023)
- [GraphMMP: A Graph Neural Network Model with Mutual Information and Global Fusion for Multimodal Medical Prognosis](https://mlsanity.com/paper/2508.17478/) (2025)

## Abstract (arXiv)

Accurate survival prediction is essential for personalized treatment planning in head and neck cancer, yet remains challenging due to the heterogeneous and high-dimensional nature of multimodal clinical data. While deep survival models have improved predictive performance over classical statistical approaches, existing methods typically rely on static fusion strategies or temporally agnostic modeling, limiting their ability to capture structured clinical workflows. In this work, we propose ChronoSurv, a heterogeneous hierarchical directed graph framework for multimodal survival analysis. ChronoSurv represents patient care as a progression-aware clinical trajectory using directed graphs aligned with key diagnostic steps. A hierarchical topology incorporates fine-grained, coarse, and global representations, further supporting flexible adaptation to missing modalities, while heterogeneous message passing models complex and asymmetric relationships across modalities and clinical steps. Experimental results on two public datasets demonstrate that ChronoSurv achieves state-of-the-art discriminative performance while maintaining statistically reliable calibration. Comprehensive ablation studies further confirm the contribution of each architectural component, highlighting the potential of trajectory-aware graph modeling for multimodal survival prediction.