When Slides Met Scans: Cross-Attention for Renal Cancer Prognosis

Anusha Krishnamoorthy, Basudha Pal

Histopathology and computed tomography (CT) provide complementary views of renal cancer. We connect these modalities through bidirectional cross-attention between 16 histology prototypes and up to 32 kidney-centered CT tokens from frozen foundation models. In 210 TCGA-KIRC patients with 46 disease-specific survival (DSS) events, 5-fold evaluation yielded a C-index of $0.760\pm0.081$ and 3-year AUROC of 0.773 (95\% CI 0.678--0.860), the highest averages among evaluated unimodal and fusion baselines. External testing in 180 CPTAC-CCRCC patients yielded DSS C-index of 0.629 with CT withheld. Attribution analysis linked predictions to image regions while exposing acquisition artifacts. These findings support further study of cross-scale fusion and independent multimodal validation.