LUNG-KGMM: Knowledge-Guided Multimodal Learning for Lung Cancer Incidence Prediction

Early identification of lung cancer risk is critical for timely intervention, yet existing prediction models are limited by their reliance on single data modalities and their inability to leverage structured clinical knowledge. We propose LUNG-KGMM, a knowledge-guided multimodal framework that integrates longitudinal electronic health records, radiology reports, chest radiograph representations, and guideline-derived knowledge for 1-to-6-year incident lung cancer prediction. To address modality heterogeneity and potential data leakage, we develop a leakage-sanitized report processing pipeline and a horizon-masked cumulative training objective that handles incomplete follow-up. We further introduce a knowledge-graph representation of clinical guidance that encodes report-triggered finding-attribute-action relations as an auditable knowledge stream. We build a multimodal development cohort from the publicly available MIMIC databases and construct a real-world validation cohort from the Xiamen Medical Big Data Platform. Extensive experiments on the MIMIC cohort demonstrate that LUNG-KGMM achieves superior performance over state-of-the-art methods, and validation on the Xiamen cohort further characterizes its cross-cohort portability and the need for local adaptation. The MIMIC development cohort is publicly accessible; the Xiamen cohort is governed by local data privacy regulations.