# Semantic-Anchored Evidential Fusion for Domain-Robust Whole-Slide Survival Analysis

arXiv: https://arxiv.org/abs/2606.19966 · HTML: https://mlsanity.com/paper/2606.19966/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 33 of its 64 references that are in the map.
- First posted on arXiv 18 Jun 2026.

## Builds on (most cited first, 30 of 33)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [Dropout as a Bayesian Approximation: Representing Model Uncertainty in Deep Learning](https://mlsanity.com/paper/1506.02142/) (2015)
- [Simple and Scalable Predictive Uncertainty Estimation using Deep Ensembles](https://mlsanity.com/paper/1612.01474/) (2016)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Attention-based Deep Multiple Instance Learning](https://mlsanity.com/paper/1802.04712/) (2018)
- [Do We Really Need to Access the Source Data? Source Hypothesis Transfer for Unsupervised Domain Adaptation](https://mlsanity.com/paper/2002.08546/) (2020)
- [Data Efficient and Weakly Supervised Computational Pathology on Whole Slide Images](https://mlsanity.com/paper/2004.09666/) (2020)
- [Evidential Deep Learning to Quantify Classification Uncertainty](https://mlsanity.com/paper/1806.01768/) (2018)
- [Dual-stream Multiple Instance Learning Network for Whole Slide Image Classification with Self-supervised Contrastive Learning](https://mlsanity.com/paper/2011.08939/) (2020)
- [A Comprehensive Survey on Test-Time Adaptation under Distribution Shifts](https://mlsanity.com/paper/2303.15361/) (2023)
- [DTFD-MIL: Double-Tier Feature Distillation Multiple Instance Learning for Histopathology Whole Slide Image Classification](https://mlsanity.com/paper/2203.12081/) (2022)
- [Quilt-1M: One Million Image-Text Pairs for Histopathology](https://mlsanity.com/paper/2306.11207/) (2023)
- [Generalized Source-free Domain Adaptation](https://mlsanity.com/paper/2108.01614/) (2021)
- [Quantifying the effects of data augmentation and stain color normalization in convolutional neural networks for computational pathology](https://mlsanity.com/paper/1902.06543/) (2019)
- [Trusted Multi-View Classification with Dynamic Evidential Fusion](https://mlsanity.com/paper/2204.11423/) (2022)
- [Visual Language Pretrained Multiple Instance Zero-Shot Transfer for Histopathology Images](https://mlsanity.com/paper/2306.07831/) (2023)
- [Artificial Intelligence for Digital and Computational Pathology](https://mlsanity.com/paper/2401.06148/) (2023)
- [Modeling Dense Multimodal Interactions Between Biological Pathways and Histology for Survival Prediction](https://mlsanity.com/paper/2304.06819/) (2023)
- [Multimodal Optimal Transport-based Co-Attention Transformer with Global Structure Consistency for Survival Prediction](https://mlsanity.com/paper/2306.08330/) (2023)
- [Attention-Challenging Multiple Instance Learning for Whole Slide Image Classification](https://mlsanity.com/paper/2311.07125/) (2023)
- [SlideChat: A Large Vision-Language Assistant for Whole-Slide Pathology Image Understanding](https://mlsanity.com/paper/2410.11761/) (2024)
- [A review of uncertainty quantification in medical image analysis: probabilistic and non-probabilistic methods](https://mlsanity.com/paper/2310.06873/) (2023)
- [Current Pathology Foundation Models are unrobust to Medical Center Differences](https://mlsanity.com/paper/2501.18055/) (2025)
- [Graph Domain Adaptation with Dual-branch Encoder and Two-level Alignment for Whole Slide Image-based Survival Prediction](https://mlsanity.com/paper/2411.14001/) (2024)
- [OTSurv: A Novel Multiple Instance Learning Framework for Survival Prediction with Heterogeneity-aware Optimal Transport](https://mlsanity.com/paper/2506.20741/) (2025)
- [Evidential time-to-event prediction with calibrated uncertainty quantification](https://mlsanity.com/paper/2411.07853/) (2024)
- [HASD: Hierarchical Adaption for pathology Slide-level Domain-shift](https://mlsanity.com/paper/2506.23673/) (2025)
- [DPsurv: Dual-Prototype Evidential Fusion for Uncertainty-Aware and Interpretable Whole-Slide Image Survival Prediction](https://mlsanity.com/paper/2510.00053/) (2025)
- [An evidential time-to-event prediction model based on Gaussian random fuzzy numbers](https://mlsanity.com/paper/2406.13487/) (2024)

## Abstract (arXiv)

Whole-slide images (WSIs) are widely used for computational cancer prognosis. However, most existing methods primarily focus on in-domain performance and fail to generalize across clinical centers. This limitation stems from their reliance on pixel-derived representations that are highly susceptible to domain-specific artifacts caused by staining protocols and scanner hardware. We hypothesize that high-level pathology semantics, such as tumor grade and micro-environmental architecture, provide a domain-invariant semantic representation that mirrors the robust diagnostic logic of human pathologists. Therefore, we propose a Semantic-Anchored Evidential Fusion Survival (SAEFS) framework, where SAEFS derives semantic anchors from WSIs via Visual Question Answering (VQA), employs a dual-stream WSI evidence extraction architecture, uses Dirichlet-based Subjective Logic to model uncertainty, and fuses semantic and visual evidence through a cautious conjunction rule to avoid overconfident fusion from correlated sources. Trained exclusively on one source domain and evaluated zero-shot across four unseen domains, SAEFS consistently outperforms state-of-the-art models both in prediction accuracy and reliability, improving the average C-index by 10.2%. Quantitative analyses further show that VQA-derived semantic features exhibit significantly lower cross-center divergence than pixel-derived features, highlighting their robustness for cross-center clinical applications.