SurvGraph: A hybrid-graph attention network for survival prediction using whole slide pathological images in gastric cancer.

Whole slide pathological images have shown significant potential for patient prognostication. Graph representation learning provides a robust framework for in-depth analysis of whole-slide images to construct predictive models. In this study, we introduce SurvGraph, an innovative graph-based deep learning network designed for gastric cancer survival prediction using whole slide pathological images. SurvGraph employs a hybrid graph construction approach that integrates multiple feature types, including color, texture, and deep learning features extracted from the pathological images to build node representations. SurvGraph utilizes a multi-head attention graph network, which performs survival prediction based on the graph structure. We evaluate the SurvGraph model on a large dataset of 708 gastric cancer patients from three independent cohorts for overall survival prediction. To assess the impact of various feature sets, we examine their performance when used individually and in combination. With five-fold cross-validation, our results demonstrate that the SurvGraph model achieves an average concordance index (C-index) of 0.706 with a standard deviation (SD) of 0.019. The proposed SurvGraph model has also attained a C-index of 0.708 (SD = 0.040) in the external testing set. In addition to baseline comparisons, we conducted a comprehensive benchmarking study comparing SurvGraph against established graph neural network architectures and multiple instance learning-based deep learning frameworks. The results indicate that the SurvGraph model outperforms the compared prediction models, suggesting its potential as a valuable tool for enhancing gastric cancer prognosis estimation.