Abstract Background: Whole-slide images (WSIs) are widely available, but matched multi-omics profiles are limited, especially when multiple modalities are required. We developed a multimodal learning framework that integrates RNA expression and DNA mutation with H colorectal cancer 0.99 for microsatellite instability; breast cancer 0.95, 0.88, and 0.81 for ER, PR, and HER2 protein subtyping and 0.74 and 0.86 for TP53 and PIK3CA mutations; renal cell carcinoma 0.60 for PBRM1 and 0.74 for BAP1 mutations; and colon adenocarcinoma 0.88 for KRAS and 0.89 for TP53 mutations. Gene overexpression tasks used The Cancer Genome Atlas with five-fold cross-validation across four seeds; lung and colorectal models used Samsung Medical Center cohorts; breast subtyping used the BCNB cohort; and renal and colon tasks used Clinical Proteomic Tumor Analysis Consortium data. Conclusions: An omics-aware patch aggregation framework co-trained with a scalable multi-omics encoder and WSIs enables accurate slide-level prediction for diverse biomarkers and tumor types and illustrates how partially paired multi-omics data can strengthen digital pathology models. AI was used for language editing only; authors are responsible for all content and approved the final version. Citation Format: Hwanil Choi, Tae Hyun Hwang, Soonyoung Lee, Jongseong Jang. Omics-aware patch aggregation via multimodal co-training with a scalable multi-omics encoder for slide-level prediction across an oncology biomarker panel abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 4207.
Choi et al. (Fri,) studied this question.
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