Machine learning-based multimodal prognostic models integrating pathology images and high-throughput omic data for overall survival prediction in cancer: a systematic review
This review identifies methodological gaps in a growing field that could improve cancer prognosis for patients, though it is an incremental synthesis of existing research.
This systematic review analyzed 48 studies that integrated whole slide pathology images and omics data to predict cancer patient survival, finding that multimodal models typically outperformed unimodal approaches with reported c-indices ranging from 0.550 to 0.857.
Multimodal machine learning integrating histopathology and molecular data shows promise for cancer prognostication. We systematically reviewed studies combining whole slide images (WSIs) and high-throughput omics to predict overall survival. Searches of EMBASE, PubMed, and Cochrane CENTRAL (12/08/2024), plus citation screening, identified eligible studies. Data extraction used CHARMS; bias was assessed with PROBAST+AI; synthesis followed SWiM and PRISMA 2020. Protocol: PROSPERO (CRD42024594745). Forty-eight studies (all since 2017) across 19 cancer types met criteria; all used The Cancer Genome Atlas. Approaches included regularised Cox regression (n=4), classical ML (n=13), and deep learning (n=31). Reported c-indices ranged 0.550-0.857; multimodal models typically outperformed unimodal ones. However, all studies showed unclear/high bias, limited external validation, and little focus on clinical utility. Multimodal WSI-omics survival prediction is a fast-growing field with promising results but needs improved methodological rigor, broader datasets, and clinical evaluation. Funded by NPIC, Leeds Teaching Hospitals NHS Trust, UK (Project 104687), supported by UKRI Industrial Strategy Challenge Fund.