用常规染色和临床数据,预测儿童狼疮肾炎治疗反应,准确率达90.1%。
Clinical-Injection Transformer with Domain-Adapted MAE for Lupus Nephritis Prognosis Prediction
- 将临床数据作为条件令牌注入注意力机制,实现多模态融合
- 在71名患儿上达到90.1%三分类准确率,优于现有方法
- 适合临床决策支持,尤其适用于资源有限的病理诊断场景
系统性红斑狼疮相关的狼疮肾炎(LN)是儿科患者中严重并发症,其病情比成人更重、肾功能预后更差。尽管临床需求迫切,目前计算病理学领域尚无针对儿童LN预后的研究。现有基于组织病理学的方法依赖多种昂贵染色协议,且未能整合互补的临床数据。为此,我们提出首个用于儿童LN三类治疗反应预测(完全缓解、部分缓解、无反应)的多模态计算病理框架,仅使用常规PAS染色活检与结构化临床数据。该框架引入两项关键技术:一是临床注入变压器(CIT),将临床特征作为条件令牌嵌入局部自注意力中,实现统一注意力空间内的隐式双向跨模态交互;二是基于领域自适应掩码自编码器(MAE)的解耦表示-知识适应策略,明确分离自监督形态特征学习与病理知识提取。此外,设计多粒度形态类型注入机制,将提炼的分类知识在个体与患者层面桥接至下游预后预测。在包含71名儿童患者的队列上评估,模型三分类准确率达90.1%,AUC为89.4%,展现出高精度与低成本的潜力。
原文摘要 · Abstract (English)
Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus that affects pediatric patients with significantly greater severity and worse renal outcomes compared to adults. Despite the urgent clinical need, predicting pediatric LN prognosis remains unexplored in computational pathology. Furthermore, the only existing histopathology-based approach for LN relies on multiple costly staining protocols and fails to integrate complementary clinical data. To address these gaps, we propose the first multimodal computational pathology framework for three-class treatment response prediction (complete remission, partial response, and no response) in pediatric LN, utilizing only routine PAS-stained biopsies and structured clinical data. Our framework introduces two key methodological innovations. First, a Clinical-Injection Transformer (CIT) embeds clinical features as condition tokens into patch-level self-attention, facilitating implicit and bidirectional cross-modal interactions within a unified attention space. Second, we design a decoupled representation-knowledge adaptation strategy using a domain-adapted Masked Autoencoder (MAE). This strategy explicitly separates self-supervised morphological feature learning from pathological knowledge extraction. Additionally, we introduce a multi-granularity morphological type injection mechanism to bridge distilled classification knowledge with downstream prognostic predictions at both the instance and patient levels. Evaluated on a cohort of 71 pediatric LN patients with KDIGO-standardized labels, our method achieves a three-class accuracy of 90.1% and an AUC of 89.4%, demonstrating its potential as a highly accurate and cost-effective prognostic tool.
Thank you to arXiv for use of its open access interoperability. PaperDance 不是 arXiv 官方产品;中文卡片由大模型生成,请以原文为准。