用预训练表结构模型做临床生存预测,效果优于传统方法
Tabular Foundation Models for Clinical Survival Analysis via Survival-Aware Adaptation

- 在预训练表数据模型上加生存感知头,直接做时间事件预测
- MIMIC-IV上C指数达0.856,比最优基线高1.4%
- 适合缺乏标注数据的临床生存分析场景
预测死亡等时间至事件结果是临床决策的核心任务,通常通过生存分析解决。传统统计与深度学习方法需任务定制训练且依赖大量标注数据。近期表结构基础模型为结构化数据提供了通用表示学习新范式,但其在存在删失的时间事件预测中应用仍不充分,因多数应用局限于离散分类而非生存分析。本文提出轻量级适配方法,将表结构基础模型用于临床生存分析,直接在预训练表示上训练生存感知头部。研究了TabPFN、TabDPT、TabICL等架构,采用多任务逻辑回归(MTLR)头建模右删失时间事件结果。在多个公开生存基准及两个大规模重症监护队列MIMIC-IV和eICU上评估。结果显示该迁移学习方法性能优于或媲美强基线。在MIMIC-IV上,TabDPT-FT-MTLR达到C指数0.856,相较最优非基础模型DeepSurv(0.844)提升1.4%,较最优零样本模型(0.802)提升6.7%。在eICU上,TabICL-FT-MTLR达0.797,较DeepSurv(0.784)提升1.7%,较零样本模型(0.749)提升6.4%。结果表明,结合预训练表征与生存感知目标至关重要,表结构基础模型为临床生存预测提供了一种实用有效的替代方案。
原文摘要 · Abstract (English)
Predicting time-to-event outcomes such as mortality is a fundamental task in clinical decision-making, commonly addressed through survival analysis. While classical statistical and deep learning approaches have been widely studied, they typically require task-specific training and sufficient labeled data. Recent advances in tabular foundation models offer a new paradigm by learning general-purpose representations for structured data. However, their applicability to censored time-to-event prediction in clinical settings remains underexplored, as typical applications are restricted to discrete classification rather than survival analysis tasks. In this work, we propose a lightweight adaptation approach for applying tabular foundation models to clinical survival analysis by directly training a survival-aware head on top of the pretrained representations. We study representative architectures, including TabPFN, TabDPT, and TabICL, and adapt them using a multi-task logistic regression (MTLR) head to model right-censored time-to-event outcomes. We evaluate this approach on a diverse set of public survival benchmarks and two large-scale ICU cohorts, MIMIC-IV and eICU. Our results show that this transfer learning approach achieves competitive or superior performance compared to strong baselines. On MIMIC-IV, TabDPT-FT-MTLR reaches a C-index of 0.856, corresponding to a relative improvement of +1.4% over the best non-FM baseline (DeepSurv, 0.844) and +6.7% over the best zero-shot model (0.802). On eICU, TabICL-FT-MTLR achieves 0.797, yielding gains of +1.7% (DeepSurv, 0.784) and +6.4% (0.749), respectively. These findings highlight the importance of combining pretrained tabular representations with survival-aware objectives and suggest that tabular foundation models provide a practical and effective alternative for clinical survival prediction.
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