MultiSigBERT: Beyond Survival Analysis through Multimodal and Sequential Modeling in Oncology

Machine learning has become an essential component of modern healthcare, where the integration of heterogeneous data sources offers unprecedented opportunities to improve clinical decision-making. Electronic Health Records (EHR) contain complementary information -- including narrative clinical reports, numerical measurements, and structured variables -- yet most survival models remain limited to a single modality or fail to exploit the temporal nature of patient trajectories. We propose MultiSigBERT, a unified framework for multimodal sequential survival modeling in oncology based on path signature representations. Here, narrative medical reports (free-text) are converted into sentence embeddings by extracting and averaging contextual word embeddings. These representations are then compressed via modality-specific PCA and concatenated with structured covariates to form joint temporal trajectories which are then encoded using the Signature transform, a tool from Rough Paths theory that efficiently captures higher-order temporal interactions across modalities without supervision needed. The computed Signature features are finally incorporated as high dimensional features into a LASSO-regularized Cox model to estimate individualized risk scores. The performance of our novel MultiSigBERT pipeline is illustrated on the analysis of a real-world oncology cohort from the L'eon B'erard Center, comprising over 120,000 medical reports and structured records from more than 2,500 patients. The model achieves a concordance index of 0.743 (sd 0.029) on an independent test set, demonstrating the benefit of jointly modeling multimodal temporal dynamics together with patient-level geometric structure for survival prediction.