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Multimodal Co-Attention Transformer for Survival Prediction in Gigapixel Whole Slide Images
Abstract
Survival outcome prediction is a challenging weakly-supervised and ordinal regression task in computational pathology that involves modeling complex interactions within the tumor microenvironment in gigapixel whole slide images (WSIs). Despite recent progress in formulating WSIs as bags for multiple instance learning (MIL), representation learning of entire WSIs remains an open and challenging problem, especially in overcoming: 1) the computational complexity of feature aggregation in large bags, and 2) the data heterogeneity gap in incorporating biological priors such as genomic measurements. In this work, we present a Multimodal Co-Attention Transformer (MCAT) framework that learns an interpretable, dense co-attention mapping between WSIs and genomic features formulated in an embedding space. Inspired by approaches in Visual Question Answering (VQA) that can attribute how word embed-dings attend to salient objects in an image when answering a question, MCAT learns how histology patches attend to genes when predicting patient survival. In addition to visualizing multimodal interactions, our co-attention trans-formation also reduces the space complexity of WSI bags, which enables the adaptation of Transformer layers as a general encoder backbone in MIL. We apply our proposed method on five different cancer datasets (4,730 WSIs, 67 million patches). Our experimental results demonstrate that the proposed method consistently achieves superior performance compared to the state-of-the-art methods.
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“In the comparison between the FSM and MCAT [6] models across the TCGA and CPTAC cohorts, the FSM model consistently demonstrated superior performance in predicting survival outcomes for both LUAD and LUSC cases.”
From Graph attention-based fusion of pathology images and gene expression for prediction of cancer survival (2024) · cites this paper as [6]
In the citing paper
“TAH is applicable to models employing attention-weighted pooling of instances, while CoAttn suits multimodal models that fuse WSI and genomic features using co-attention.”
From Graph attention-based fusion of pathology images and gene expression for prediction of cancer survival (2024) · cites this paper as [6]
In the citing paper
“While other researchers have previously explored the development of mid-level-fusion and mixer architectures [6], [7] as well as the use of graph-based representations of WSIs [8], our work is unique in mixing node and edge embeddings along with fusion of bulk gene expression embeddings to learn a multimodal topographic mapping to predict survival.”
From Graph attention-based fusion of pathology images and gene expression for prediction of cancer survival (2024) · cites this paper as [6]
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Qiu, L., Zhao, L., Zhao, W., & Zhao, J. (2024) · Physics in Medicine and Biology · doi:10.1088/1361-6560/ad37ec · Cited by 5
Deep Learning-based Modeling for Preclinical Drug Safety AssessmentPreprint
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Self-citationKatare, D., Leroux, S., Janssen, M., & Ding, A. Y. (2025) · Computing · doi:10.1007/s00607-025-01427-w · Cited by 4
Prototype-Guided Cross-Modal Knowledge Enhancement for Adaptive Survival Prediction
Liu, F., Cai, L., Wang, Z., Fan, Z., Yu, J.-G., Chen, H., & Zhang, Y. (2025) · Lecture notes in computer science · doi:10.1007/978-3-032-04978-0_50 · Cited by 6
PTCMIL: Multiple Instance Learning via Prompt Token Clustering for Whole Slide Image Analysis
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A fake news detection framework integrating multi-domain and multimodal features
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Luo, H., Huang, J., Zhou, T., Wu, E., & Ding, W. (2025) · IEEE Transactions on Fuzzy Systems · doi:10.1109/tfuzz.2025.3609687 · Cited by 5
Yu, S., Chen, X., Cao, F., & Tian, T. (2025) · IEEE International Conference on Acoustics Speech and Signal Processing · doi:10.1109/icassp49660.2025.10888939 · Cited by 5
Li, C., Huang, P., Qin, J., & Luo, X. (2025) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2025.3609838 · Cited by 10
Liu, M., Cai, C., Li, J., Xu, P., Li, J., Ma, J., & Xu, J. (2025) · Lecture notes in computer science · doi:10.1007/978-3-032-05182-0_39 · Cited by 5
Fu, B., He, J., Zhang, X., Peng, Y., Zhang, Z., Tang, Q., Liu, X., Cao, Y., & Wang, R. (2025) · Medical Image Analysis · doi:10.1016/j.media.2025.103810 · Cited by 4
Deep learning-based multimodal pathogenomics integration for precision cancer prognosis
Feng, X., Song, G., Zhang, Y., Guo, L., Jiang, Y., Gong, W., Feng, Y., Xu, C., Yang, Y., & He, M. (2026) · Journal of Translational Medicine · doi:10.1186/s12967-026-07682-5 · Cited by 4
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Wang, H., Wei, L., Li, J., Liu, B., Fang, J., & Mooney, C. (2026) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2026.109288 · Cited by 5
Lightweight multimodal Cycle-Attention Transformer towards cancer diagnosis
Liu, S., Ma, X., Deng, S., Suo, Y., Zhang, J., & Ng, W. W. Y. (2024) · Expert Systems with Applications · doi:10.1016/j.eswa.2024.124616 · Cited by 4
ContraMAE: Contrastive alignment masked autoencoder framework for cancer survival prediction
Wang, S., Lai, H., Wang, S., & Zhang, Q. (2024) · IEEE International Conference on Bioinformatics and Biomedicine (BIBM) · doi:10.1109/bibm62325.2024.10821720 · Cited by 4
Qu, M., Yang, G., Di, D., Gao, Y., Su, T., Song, Y., & Fan, L. (2025) · Lecture notes in computer science · doi:10.1007/978-3-032-05127-1_31 · Cited by 7
Metadata
- Authors
- Chen, R. J., Lu, M. Y., Weng, W.-H., Chen, T. Y., Williamson, D. F., Manz, T., Shady, M., & Mahmood, F.
- Affiliations
- Broad Institute (US)
- MIT Computer Science and Artificial Intelligence Laboratory (US)
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- 2021 IEEE/CVF International Conference on Computer Vision (ICCV)
- Publisher
- IEEE
- Published
- 2021-10
- Pages
- 3995-4005
- OpenAlex
- W3203898052
- Cited by
- 398
- References
- 75
- Citations by year
- 2026: 106 · 2025: 121 · 2024: 94 · 2023: 55 · 2022: 22
- FWCI
- 19.71
- Type
- conference paper
- Language
- en
- Open access
- closed
- Locations
- IEEE/CVF International Conference on Computer Vision (ICCV) (publishedVersion)
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › AI in cancer detection
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Multimodal Machine Learning Applications
- Keywords
- survival prediction, whole slide images, multimodal representation learning, multiple instance learning, genomic features, tumor microenvironment, visual question answering, ordinal regression, cancer
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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