Colorectal Cancer Survival Prediction Using Deep Distribution Based Multiple-Instance Learning

Most deep-learning algorithms that use Hematoxylin- and Eosin-stained whole slide images (WSIs) to predict cancer survival incorporate image patches either with the highest scores or a combination of both the highest and lowest scores. In this study, we hypothesize that incorporating wholistic patch information can predict colorectal cancer (CRC) cancer survival more accurately. As such, we developed a distribution-based multiple-instance survival learning algorithm (DeepDisMISL) to validate this hypothesis on two large international CRC WSIs datasets called MCO CRC and TCGA COAD-READ. Our results suggest that combining patches that are scored based on percentile distributions together with the patches that are scored as highest and lowest drastically improves the performance of CRC survival prediction. Including multiple neighborhood instances around each selected distribution location (e.g., percentiles) could further improve the prediction. DeepDisMISL demonstrated superior predictive ability compared to other recently published, state-of-the-art algorithms. Furthermore, DeepDisMISL is interpretable and can assist clinicians in understanding the relationship between cancer morphological phenotypes and a patient's cancer survival risk.