Yue Lyu, Steven H. Lin, Xuelin Huang +1stat.ME stat.ML
Time-to-event prediction from tabular patient data is central to prognosis and biomedical decision support, but right-censored follow-up prevents direct use of ordinary regression labels. Tabular foundation models offer reusable prediction machinery for modest heterogeneous datasets, yet they generally assume fully observed outcomes. We introduce SurvFM-RMST, a censoring-aware target-interface framework that converts survival outcomes into jackknife pseudo-observation targets for restricted mean survival time, enabling multiple tabular backbones to perform horizon-specific RMST regression without survival-specific fine-tuning. In controlled simulations with known conditional RMST, SurvFM-RMST recovered restricted event-free time accurately, and pseudo-RMST targets outperformed naive restricted observed-time and event-only targets. Across 36 eligible static SurvSet datasets, SurvFM backbones were competitive with established survival and RMST-regression comparators, though relative performance varied by endpoint, horizon and practical constraints. Predicted RMST further stratified held-out patients into groups with ordered observed event-free time and event enrichment. Overall, the results support pseudo-RMST target construction as a portable interface between censored survival data and tabular foundation-model prediction.
Accurate time-to-event (TTE) prediction from multimodal clinical data remains challenging due to modality imbalance and distribution shift. We introduce a foundation model-driven framework for cross-modal representation alignment between CT imaging and longitudinal EHR data, designed to generalize across tasks and institutions. CT and EHR modalities are encoded independently using domain-specific foundation models and aligned in a shared latent space through four principled fusion strategies: late fusion, contrastive alignment, cross-attention, and co-attention. We evaluate two clinically distinct TTE tasks: pulmonary embolism (PE) mortality and cardiovascular disease (CVD) outcomes, on large-scale multi-institutional cohorts (PE: N=3,099 train; 1,098 internal; 435 external; CVD: N=2,951 train; 837 internal; 682 external). Fusion consistently improves concordance index by 1.5-5.4% over unimodal baselines when modalities contribute comparably. Overall, contrastive multimodal fusion, particularly with CLMBR representations, provided the most consistent and statistically robust improvements, especially for PE mortality prediction. For MACE, cross-attention (one-hot) achieved the highest internal performance and image-guided co-attention achieved the best external performance. We therefore introduce a generalizable foundation model-based cross-modal alignment framework and provide the first systematic analysis of fusion behavior under modality imbalance in TTE prediction. Our results establish task-aware multimodal alignment as a necessary design principle for robust generalization and scalable clinical deployment.