Reliable Multimodal Cancer Survival Prediction with Confidence-aware Risk Modeling

Multimodal survival methods that integrate histology whole-slide images and transcriptomic profiles hold significant promise for understanding patient prognostication and guiding personalized treatment strategies. However, existing approaches primarily focus on improving predictive performance through multimodal information fusion, often neglecting the reliability estimation of the prediction results and the inherent alignment noise across modalities. Thus, we propose ReCaSP, a novel and reliable cancer survival prediction framework that effectively integrates histology and transcriptomics data via multimodal alignment and fusion, providing the auxiliary confidence levels for survival predictions through a confidence-aware risk modeling mechanism. Specifically, our approach incorporates a fine-grained risk classifier that models risk labels jointly over both multiple time intervals and censorship status, utilizing evidential deep learning to yield fine-grained risk predictions accompanied by confidence scores. Additionally, to mitigate the inherent noise in multimodal data alignment, we introduce a cross-attention alignment module that effectively aligns histology data with transcriptomics data prior to multimodal fusion, thereby facilitating cross-modal interaction learning. Extensive experiments on five datasets demonstrate that ReCaSP significantly outperforms state-of-the-art methods, achieving a 4.58% improvement in the overall C-Index.