Comprehensive Multimodal Deep Learning Survival Prediction Enabled by a Transformer Architecture: A Multicenter Study in Glioblastoma
<|reference_start|>Comprehensive Multimodal Deep Learning Survival Prediction Enabled by a Transformer Architecture: A Multicenter Study in Glioblastoma: Background: This research aims to improve glioblastoma survival prediction by integrating MR images, clinical and molecular-pathologic data in a transformer-based deep learning model, addressing data heterogeneity and performance generalizability. Method: We propose and evaluate a transformer-based non-linear and non-proportional survival prediction model. The model employs self-supervised learning techniques to effectively encode the high-dimensional MRI input for integration with non-imaging data using cross-attention. To demonstrate model generalizability, the model is assessed with the time-dependent concordance index (Cdt) in two training setups using three independent public test sets: UPenn-GBM, UCSF-PDGM, and RHUH-GBM, each comprising 378, 366, and 36 cases, respectively. Results: The proposed transformer model achieved promising performance for imaging as well as non-imaging data, effectively integrating both modalities for enhanced performance (UPenn-GBM test-set, imaging Cdt 0.645, multimodal Cdt 0.707) while outperforming state-of-the-art late-fusion 3D-CNN-based models. Consistent performance was observed across the three independent multicenter test sets with Cdt values of 0.707 (UPenn-GBM, internal test set), 0.672 (UCSF-PDGM, first external test set) and 0.618 (RHUH-GBM, second external test set). The model achieved significant discrimination between patients with favorable and unfavorable survival for all three datasets (logrank p 1.9\times{10}^{-8}, 9.7\times{10}^{-3}, and 1.2\times{10}^{-2}). Conclusions: The proposed transformer-based survival prediction model integrates complementary information from diverse input modalities, contributing to improved glioblastoma survival prediction compared to state-of-the-art methods. Consistent performance was observed across institutions supporting model generalizability.<|reference_end|>
@article{gomaa2024comprehensive,
    title={Comprehensive Multimodal Deep Learning Survival Prediction Enabled by a
  Transformer Architecture: A Multicenter Study in Glioblastoma},
    author={Ahmed Gomaa, Yixing Huang, Amr Hagag, Charlotte Schmitter, Daniel
  H"ofler, Thomas Weissmann, Katharina Breininger, Manuel Schmidt, Jenny
  Stritzelberger, Daniel Delev, Roland Coras, Arnd D"orfler, Oliver Schnell,
  Benjamin Frey, Udo S. Gaipl, Sabine Semrau, Christoph Bert, Rainer Fietkau,
  and Florian Putz},
    journal={arXiv preprint arXiv:2405.12963},
    year={2024},
    archivePrefix={arXiv},
    eprint={2405.12963},
    primaryClass={eess.IV cs.CV cs.LG}
}