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    基于主动证据路由的癌症生存预测方法

    PathRoute: Active Evidence Routing for Cancer Survival Prediction on Whole Slide Pathology Images

    • 摘要: 病理全切片图像(Whole Slide Image, WSI)是癌症诊断与预后判断的核心载体。 当前主流的病理全切片生存预测方法将海量的区块特征直接映射为全局表示并输出预后风险,不仅未能在建模中显式区分复杂的组织学构成、忽略了不同癌种特有的临床表型差异,也导致模型的内部推理过程缺乏可解释性。 针对上述问题,本文提出PathRoute,一个面向可解释生存预测的主动证据路由框架。该框架将WSI推理建模为先形成证据、再读出风险的两阶段有向过程:四类角色明确的可学习查询在统一隐空间中分工协作,分别承担组织组成感知、主动证据路由、表型语义辅助监督与风险读出;方向性注意力掩码进一步约束查询间的前向可见性,使风险预测在架构上成为前序证据表示的下游读出,而非端到端的黑盒映射。 在TCGA五个常见实体瘤癌种上,采用统一输入特征与相同患者级5折交叉验证划分,PathRoute仅使用WSI作为输入,平均生存预测C-index优于代表性多模态融合方法与纯WSI方法,验证了结构化证据组织的有效性。进一步的分析表明,路由查询在未接受任何组织类型监督的条件下,仍在五个癌种上稳定地将注意力自发集中于肿瘤区域,为主动证据路由的可解释性提供了直接支撑。代码目前已在https://github.com/ZephyrGo/pathRoute开源

       

      Abstract: Whole slide images (WSIs) are central to cancer diagnosis and prognosis. However, mainstream survival prediction methods directly map massive tile features into a single global representation for risk readout, failing to explicitly distinguish complex histological composition, ignoring cancer-specific clinical phenotype differences, and leaving the model’s internal reasoning process opaque. To address these issues, we propose PathRoute, an active evidence routing framework for interpretable WSI survival prediction. The framework models WSI reasoning as a two-stage directional process that first forms evidence and then reads out risk: four role-specific learnable queries collaborate in a shared latent space, respectively performing tissue-composition sensing, active evidence routing, phenotype-semantic auxiliary supervision, and risk readout; a directional attention mask further constrains forward visibility between queries, so that risk prediction is structurally realized as a downstream readout of pre-formed evidence representations, rather than an end-to-end black-box mapping. On five TCGA solid tumor cohorts under unified inputs and identical patient-level 5-fold cross-validation splits, PathRoute using WSI alone achieves higher average C-index than representative multimodal and WSI-only methods, validating the effectiveness of structured evidence organization. Further analysis shows that routing queries consistently and spontaneously concentrate attention onto tumor regions across all five cancer types without any tissue-type supervision, providing direct interpretability support for the active routing mechanism. Code available at https://github.com/ZephyrGo/pathRoute.

       

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