Esophageal cancer is one of the most lethal cancers, with 5-year survival rate of only 20%. Patient outcomes can vary significantly even though they are at the same cancer stage and receive similar treatments. Accurate prognostic prediction for esophageal cancer patients is highly desired to receive personalized precise treatment. Nevertheless, there are very few automated methods yet to fully exploit the preoperative contrast-enhanced computed tomography (CE-CT) imaging for assessing esophageal cancer prognosis. In addition to image patterns, important prognostic factors should encompass tumor size and location, as well as lymph nodes (LNs) involvement, including features such as LN number, size, spatial distribution, and their proximity to tumor. Considering these complexities, we propose a novel Tumor and LN Context-Geometry network for the preoperative prediction of esophageal cancer survival in CE-CT images. Specifically, we 1) focus on learning survival patterns of CT texture via co-attention context modeling at most informative regions, i.e., automatically segmented tumor, LNs and LN-stations; and 2) integrate tumor and LN anatomical and spatial associations into neural geometry modeling for a comprehensive learning of metastatic involvement and tumor invasion to adjacent structures. Empirical studies show our presented framework can improve overall survival prediction performances compared with existing state-of-the-art survival analysis methods, and evidently suggest that incorporating these findings into the existing esophageal cancer staging system would add its clinical values.

Diagnosing malignant skin tumors accurately at an early stage can be challenging due to ambiguous and even confusing visual characteristics displayed by various categories of skin tumors. To improve diagnosis precision, all available clinical data from multiple sources, particularly clinical images, dermoscopy images, and medical history, could be considered. Aligning with clinical practice, we propose a novel Transformer model, named RemixFormer++ that consists of a clinical image branch, a dermoscopy image branch, and a metadata branch. Given the unique characteristics inherent in clinical and dermoscopy images, specialized attention strategies are adopted for each type. Clinical images are processed through a top-down architecture, capturing both localized lesion details and global contextual information. Conversely, dermoscopy images undergo a bottom-up processing with two-level hierarchical encoders, designed to pinpoint fine-grained structural and textural features. A dedicated metadata branch seamlessly integrates non-visual information by encoding relevant patient data. Fusing features from three branches substantially boosts disease classification accuracy. RemixFormer++ demonstrates exceptional performance on four single-modality datasets (PAD-UFES-20, ISIC 2017/2018/2019). Compared with the previous best method using a public multi-modal Derm7pt dataset, we achieved an absolute 5.3% increase in averaged F1 and 1.2% in accuracy for the classification of five skin tumors. Furthermore, using a large-scale in-house dataset of 10,351 patients with the twelve most common skin tumors, our method obtained an overall classification accuracy of 92.6%. These promising results, on par or better with the performance of 191 dermatologists through a comprehensive reader study, evidently imply the potential clinical usability of our method.

A core challenge in survival analysis is to model the distribution of time-to-event data, where the event of interest may be a death, failure, or occurrence of a specific event. Previous studies have showed that ranking and maximum likelihood estimation loss functions are widely-used learning approaches for survival analysis. However, ranking loss only focus on the ranking of survival time and does not consider potential effect of samples’ exact survival time values. Furthermore, the maximum likelihood estimation is unbounded and easily subject to outliers (e.g., censored data), which may cause poor performance of modeling. To handle the complexities of learning process and exploit valuable survival time values, we propose a time-adaptive coordinate loss function, TripleSurv, to achieve adaptive adjustments by introducing the differences in the survival time between sample pairs into the ranking, which can encourage the model to quantitatively rank relative risk of pairs, ultimately enhancing the accuracy of predictions. Most importantly, the TripleSurv is proficient in quantifying the relative risk between samples by ranking ordering of pairs, and consider the time interval as a trade-off to calibrate the robustness of model over sample distribution. Our TripleSurv is evaluated on three real-world survival datasets and a public synthetic dataset. The results show that our method outperforms the state-of-the-art methods and exhibits good model performance and robustness on modeling various sophisticated data distributions with different censor rates.

Gastric cancer (GC) is the third leading cause of cancer-associated deaths globally. Accurate risk prediction of the overall survival (OS) for GC patients shows significant prognostic value, which helps identify and classify patients into different risk groups to benefit from personalized treatment. Many methods based on machine learning algorithms have been widely explored to predict the risk of OS. However, the accuracy of risk prediction has been limited and remains a challenge with existing methods. Few studies have proposed a framework and pay attention to the low-level and high-level features separately for the risk prediction of OS based on computed tomography images of GC patients. To achieve high accuracy, we propose a multi-focus fusion convolutional neural network. The network focuses on low-level and high-level features, where a subnet to focus on lower-level features and the other enhanced subnet with lateral connection to focus on higher-level semantic features. Three independent datasets of 640 GC patients are used to assess our method. Our proposed network is evaluated by metrics of the concordance index and hazard ratio. Our network outperforms state-of-the-art methods with the highest concordance index and hazard ratio in independent validation and test sets. Our results prove that our architecture can unify the separate low-level and high-level features into a single framework, and can be a powerful method for accurate risk prediction of OS.