Author Correction: MAGE-A4/MAGE-A8-targeted TCR-based bispecific T cell engager in recurrent and/or refractory solid tumors: a phase 1 trial
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arXiv:2606.19759v1 Announce Type: new Abstract: As individuals turn to the Internet to find answers to questions they may have, several Question Answering (QA) forums have evolved, where users knowledgeable in certain topics can contribute their expertise to answering these requests for information. While these are currently volunteer based, we consider a future version employing knowledge workers who are experts in certain topics. In such a system, the request-answer processes forming the queuing system may utilize schedulers that assign requests in different topics to the experts in the forum, who may be able to answer them according to their expertise levels in different topics. With this model, we calculate the capacity of the system for handling the requests while keeping the system stable, and design schedulers that achieve capacity. We also investigate how collaboration between experts in answering requests can potentially increase capacity.
Characterising the tumour microenvironment (TME) from routine H&E-stained histology images requires simultaneous cell segmentation, feature extraction, and interpretable clinical reporting. We present SEGTME-UNI2, a unified framework addressing these requirements. Its core is UNI2-UPERHOVER, a dual-head segmentation model pairing the UNI2-H pathology foundation model (ViT-Giant, pretrained on >100M tiles from 100K slides) with two parallel UperNet decoders: one for six-class semantic segmentation and one for horizontal-vertical gradient regression enabling watershed-based nuclear instance separation. To address the lack of pixel-level annotations in large real-world repositories, UNI2-UPERHOVER undergoes a three-stage progressive pseudo-label curriculum. Each stage trains a fresh model without weight transfer, driving improvement entirely via increased pseudo-label quality: Stage 1: Uses human-annotated PanNuke (7,901 images, 189,744 nuclei, 0.25 um/pixel). Stage 2: Uses entropy-filtered pseudo-labels from the Stage 1 model on 271,711 TCGA-UT scale-0 patches (0.5 um/pixel). Stage 3: Uses pseudo-labels from the Stage 2 model on all 1,608,060 TCGA-UT patches across six resolution scales (0.5-1.0 um/pixel). Segmentation outputs feed a structured TME feature extraction pipeline computing 20+ per-patch compositional, morphological, spatial entropy, and intercellular distance metrics. These are encoded as JSON and passed to a fine-tuned NVIDIA BioNeMo GPT model to generate clinically interpretable TME narratives. Preliminary validation on held-out PanNuke and TCGA-UT partitions demonstrates framework feasibility and internal consistency. The pseudo-labelled TCGA-UT dataset and UNI2-UPERHOVER checkpoint are publicly released to support large-scale TME profiling and spatial biology research.
arXiv:2606.17646v1 Announce Type: cross Abstract: Saliency map visualizations explain image-based AI predictions by pointing to regions, but these are often unintuitive and semantically unclear, leaving an interpretability gap. We argue that AI explanations should be intuitive – coherent to user knowledge, yet simple and selective to accelerate interpretation. Inspired by artistic drawings, we propose SketchXplain to generate sketch-based visual explanations for intuitive image-based explainable AI (XAI). Combining techniques in saliency maps, concept-bottleneck models, and sketch optimization, SketchXplain integrates saliency to select coherent observation artifacts, concepts for knowledge coherence, cues to represent them, and abstraction for simplicity. Evaluating on face expression recognition, modeling and user studies showed that SketchXplain supported quicker interpretation with more aligned visualizations than saliency maps or simple drawings. Further evaluation on skin lesion diagnosis found that SketchXplain more coherently visualized disease symptoms, better supporting lay diagnosis. Thus, this work illustrates the value of sketches for intuitive, simple, coherent, and quick image-based XAI visualizations.
Domains are the basic units of protein structure and function. Appropriate inter-domain organization is critical to enable cooperative execution of multiple related functions. It is thus a crucial step to determine the full-length structure of multi-domain proteins for the purpose of elucidating their functions and designing new drugs to regulate these functions. Existing structure prediction algorithms are generally better at solving the internal conformation of domains, rather than modeling the relative positions between domains. To address the challenge of accurately determining multi-domain protein conformations, we develop a single-sequence-based domain assembly algorithm called DDI_single. DDI_single directly extracts features from the amino acid sequence using the protein language model ESM-1b, and accurately predicts the interactions between residue pairs of structural domains through a novel gated cross-attention module, thus achieving the correct assembly of structural domains. With the knowledge of domain definition, DDI_single achieves more than 20% higher accuracy in the task of predicting the relative distances of residue pairs between domains than that of the single-sequence-based structure prediction algorithm trRosettaX_single. When assembling domains with known spatial conformations, DDI_single correctly assembles 74.4% of the samples in the test set (TM-score>0.5). When assembling domains with unknown spatial conformations, in cases where the internal spatial conformations of domains are correctly modeled, DDI_single correctly assembles 73.9% of the samples.
arXiv:2606.17062v1 Announce Type: cross Abstract: Radiology report evaluation must distinguish clinical compatibility from surface similarity, because negation, laterality, or normal-abnormal polarity can reverse a finding. We propose RadSEM (Radiology Sentence-Level Evaluation Metric), a constrained LLM-assisted metric for reference-based evaluation of radiology Findings. RadSEM rewrites reference and generated reports into ordered atomic finding sentences, each expressing one site-finding proposition. It then performs contradiction-constrained many-to-many matching: incompatible pairs such as "effusion" and "no effusion" receive no credit, while compatible granularity differences can receive partial credit. A deterministic stage weights pairs by part-whole and abnormal-detail relationships, counts unmatched findings, and produces an abnormal-focused weighted F1 score. Thus, the LLM supports structured rewriting and local alignment rather than acting as an opaque judge. We evaluate RadSEM with SSREE, a controlled monotonicity stress test built from 2,448 de-identified reports expanded into five graded corruption levels. RadSEM achieves Kendall tau_b of 0.957, all-pairs concordance of 97.8%, adjacent concordance of 95.0%, and strict five-level ordering for 81.9% of reports, outperforming radiology-specific and general text metrics while avoiding the failure in which polarity-inverted reports regain lexical overlap. On the same SSREE set, RadSEM outperforms the Ref-anchored RadSEM-Alt policy, improving adjacent concordance from 90.7% to 95.0% and strict ordering from 67.2% to 81.9%. On a 599-triplet synonym/antonym subset, RadSEM prefers synonyms in 597 cases (99.67%). These results suggest that explicit finding units, contradiction-aware matching, and abnormal-focused deterministic scoring make report scoring more interpretable and sensitive to clinically meaningful errors. Code is available at https://github.com/jdh-algo/RadSEM.
Multi-view imaging, such as mammography and chest radiography, is a standard component of clinical practice. However, medical images are often unregistered and contain view-specific artifacts or irrelevant background cues that can obscure diagnostically relevant findings. Many existing methods directly fuse per-view representations, allowing such irrelevant content to contaminate the fused embedding and reducing robustness under varying view configurations. We propose OTCHA, a confidence-aware latent hub token alignment module based on optimal transport (OT) that refines patch tokens before fusion for multi-view classification. OTCHA introduces a set of learnable latent hub tokens shared across views. For each view, we compute an OT plan between patch tokens and hub tokens that jointly considers feature similarity and geometry, and augment the OT formulation with token-conditional dustbins to enable partial matching and discard irrelevant tokens. The resulting transport plan provides token-wise matching confidence, which gates hub-mediated message passing and weights a novel optimal-transport-based representation alignment loss to stabilize refinement. Experiments on three multi-view medical image datasets demonstrate consistent improvements over competing baselines across diverse anatomies and view configurations. Our code is available at https://github.com/labhai/OTCHA.
arXiv:2602.09222v2 Announce Type: replace-cross Abstract: Large language model (LLM) based web agents are increasingly deployed to automate complex online tasks by directly interacting with web sites and performing actions on users' behalf. While these agents offer powerful capabilities, their design exposes them to indirect prompt injection attacks embedded in untrusted web content, enabling adversaries to hijack agent behavior and violate user intent. Despite growing awareness of this threat, existing evaluations rely on fixed attack templates, manually selected injection surfaces, or narrowly scoped scenarios, limiting their ability to capture realistic, adaptive attacks encountered in practice. We present MUZZLE, an automated agentic framework for evaluating the security of web agents against indirect prompt injection attacks. MUZZLE utilizes the agent's trajectories to automatically identify high-salience injection surfaces, and adaptively generate context-aware malicious instructions that target violations of confidentiality, integrity, and availability. Unlike prior approaches, MUZZLE adapts its attack strategy based on the agent's observed execution trajectory and iteratively refines attacks using feedback from failed executions. We evaluate MUZZLE across diverse web applications, user tasks, and agent configurations, demonstrating its ability to automatically and adaptively assess the security of web agents with minimal human intervention. Our results show that MUZZLE effectively discovers 44 new attacks on 4 web applications with 10 adversarial objectives that violate confidentiality, availability, or privacy properties across different LLMs and agent scaffolds. MUZZLE also identifies novel attack strategies, including 3 cross-application prompt injection attacks and an agent-tailored phishing scenario.
arXiv:2512.03077v2 Announce Type: replace-cross Abstract: The accelerated development, deployment and adoption of artificial intelligence systems has been fuelled by the increasing presence of big tech in the AI field. This trend has been accompanied by growing ethical concerns and intensified societal and environmental impacts. This position paper argues that irresponsible AI development is strongly driven by big tech's influence and involvement in the field. First, we examine the growing and disproportionate influence of big tech in AI research and argue that its drive for scaling and general-purpose systems is fundamentally at odds with the responsible, ethical, and sustainable development of AI. Second, we review key current environmental and societal negative impacts of AI and trace their connections to big tech's influence. Third, we discuss the underlying economic forces driving big tech's actions. Finally, as a call to action, we invite AI researchers to counter big tech's influence in irresponsible AI development through strategies that build on the responsibility of implicated actors and collective action.
arXiv:2510.00831v2 Announce Type: replace Abstract: The increasing complexity of modern power systems, driven by the integration of inverter-based and distributed energy resources, challenges the reliability of conventional protection schemes and motivates the use of machine learning for protection tasks. However, published results are often difficult to compare because datasets, sensing assumptions, and decision horizons vary across studies. This paper presents a controlled comparison of machine learning models for fault classification (FC) and fault localization (FL) under identical sensing, timing, and validation conditions on a common electromagnetic transient dataset, using decision windows of 10-50 ms to reflect protection-relevant time scales. For FC, the best-performing nonlinear models achieve F1 scores above 0.98 already at 10 ms, while lower-capacity models degrade at shorter horizons but improve with longer windows, indicating that relevant fault-type information is already present in the earliest transient. For FL, the top-performing models reach a stable localization error of about 10 % of normalized line length across all evaluated horizons, while weaker models form a clearly separated second performance tier. Line-resolved analysis shows that localization accuracy varies across grid segments, indicating topology-dependent difficulty rather than insufficient temporal context alone. These findings provide a controlled reference for comparing machine learning models across two protection tasks with fundamentally different information requirements.
arXiv:2606.18479v1 Announce Type: new Abstract: Reject inference methods are widely used to mitigate survival bias in credit scoring, yet their effectiveness remains poorly understood. We systematically evaluate several such methods and uncover a structural failure mode: in a natural retraining cycle, models whose accuracy improves while recall collapses create an illusion of improvement that leads practitioners to believe the system is getting better when, in fact, its rejection quality – the ability to correctly screen out defaulters – is deteriorating. We then propose a controlled exploration strategy that breaks the feedback loop without statistical assumptions: the lender deliberately approves a fraction of rejected applicants and observes their true outcomes. We show that accuracy and rejection quality give opposite recommendations on whether to explore: accuracy favors no exploration, while rejection quality improves with it, confirming that standard evaluation metrics are misleading under selection bias. Even minimal exploration rates (2–5\%) prove sufficient in our experiments to diagnose the severity of the feedback loop at near-zero cost. Our findings are consistent across two machine learning methods and three real-world datasets, and suggest that standard evaluation protocols are inadequate for assessing models trained under survival bias.
arXiv:2606.19310v1 Announce Type: cross Abstract: The maximum power extractable from a quantum thermoelectric heat engine operating with free fermion carriers is bounded by the universal Whitney limit, $P_{fermion}^{\max} \simeq 0.0321\pi^2 k_B^2(T_L-T_R)^2/h$. We demonstrate that this bound is not fundamental to quantum heat engines but is instead an artifact of fermionic statistics. Within the nonlinear Landauer-B\"{u}ttiker framework, a bosonic working medium yields a strictly enhanced universal maximum power, $P_{boson}^{\max} = (\ln 2)^2\, k_B^2(T_L-T_R)^2/h$, exceeding the fermionic limit by a factor of $(\ln 2)^2/(0.0321\pi^2) \approx 1.52$. We propose magnon transport through a ferromagnetic spin chain as an experimentally viable bosonic realization. Incorporating Haldane fractional exclusion statistics with parameter $g$ provides a continuous interpolation between the bosonic ($g = 0$) and fermionic ($g = 1$) limits, revealing a monotonic enhancement of maximum power for $g < 1$ at reduced bias cost. These results establish quantum statistical exclusion as a previously unrecognized and independently tunable thermodynamic resource, opening performance regimes inaccessible to conventional carrier-engineering approaches.
Large language models now produce legal text of at least median quality, yet no existing benchmark can evaluate whether they perform doctrinal legal reasoning, which forms the interpretive core of legal work, rather than the ancillary, paralegal tasks that most current legal-AI evaluations measure. This measurement gap is not only methodological but legal: the EU AI Act makes "appropriate accuracy" a binding requirement for high-risk AI used in the judicial domain, yet that requirement cannot acquire operational content without the very doctrinal-reasoning benchmark the field lacks.
arXiv:2606.13258v1 Announce Type: new Abstract: Gait-based Parkinson's disease assessment increasingly relies on heterogeneous sensors, but clinical systems rarely collect all modalities simultaneously. New sensors may arrive through device upgrades, protocol changes, or multi-center deployment, while historical patient data are often unavailable because of privacy and storage constraints. This modality-incremental setting faces three challenges: unreliable cross-modal distillation, modality-specific statistical shifts, and reduced plasticity after preservation. We propose MOSAIC, a compact continual learning framework. First, we identify the Toxic Teacher phenomenon and introduce Modality-Specific Warm-Up to stabilize newly learned modality representations before distillation. Second, we propose a statistics-decoupled MSBN architecture that isolates sensor statistics while maintaining a shared semantic backbone. Third, we design a curriculum-guided repulsive objective for Plasticity Recovery, preserving legacy knowledge while recovering modality-specific capacity. Experiments on three multimodal Parkinson's gait datasets show that MOSAIC improves final performance and mitigates forgetting. Project code is available at: https://github.com/minlinzeng/MOSAIC_Modality-Specific-Adaptation-for-Incremental-Continual-Learning-in-PD-Gait-Assessment.git
Geometric shapes play important roles in both physical world and human cognition. While multimodal large language models (MLLMs) have made significant advancements in visual understanding, their abilities to recognize geometric shapes and their spatial relationships, which we term geometric perception, are not explicitly and systematically explored. To address this gap, we introduce GePBench, a novel benchmark specifically designed to assess the geometric perception capabilities of MLLMs. Our extensive evaluations reveal that even the current state-of-the-art MLLMs exhibit significant deficiencies in geometric perception tasks. Furthermore, we show that models trained with GePBench data demonstrate considerable improvements on a wide range of downstream tasks, highlighting the critical role of geometric perception in enabling advanced multimodal applications. Our code and datasets are available at \href{https://github.com/Changhao-Xiang/GePBench}{https://github.com/Changhao-Xiang/GePBench}.
Clinical NLP increasingly relies on electronic health record (EHR) data to detect suicidal behaviors, treating clinical documentation as more reliable ground truth than social media. We argue that this framing obscures how EHR-based suicidality datasets encode a particular operationalization of suicidality, shaped by who authors the data, how episodes are bounded, and how ambiguity is resolved. We ground this argument in a case study of the ScAN dataset, built over MIMIC-III clinical notes. We show how governance constraints, ICD-based cohort selection, single-annotator labeling, and hospital-stay-level aggregation produce labels that reflect clinician-documented judgments, treat suicidality as a bounded episode, and assume that intent can be reliably inferred from documentation. A linguistic analysis demonstrates that identical labels subsume heterogeneous clinical framings differing in temporality, negation, and uncertainty. We argue that clinical NLP should examine the assumptions embedded in suicidality datasets before interpreting their labels as ground truth.
arXiv:2602.12753v2 Announce Type: replace Abstract: The successor representation (SR) provides a powerful framework for decoupling predictive dynamics from rewards, enabling rapid generalisation across reward configurations. However, the classical SR is limited by its inherent policy dependence: policies change due to ongoing learning, environmental non-stationarities, and changes in task demands, making established predictive representations obsolete. Furthermore, in topologically complex environments, SRs suffer from spectral diffusion, leading to dense and overlapping features that scale poorly. Here we propose the Hierarchical Successor Representation (HSR) for overcoming these limitations. By incorporating temporal abstractions into the construction of predictive representations, HSR learns stable state features which are robust to task-induced policy changes. Applying non-negative matrix factorisation (NMF) to the HSR yields a sparse, low-rank state representation that facilitates highly sample-efficient transfer to novel tasks in multi-compartmental environments. Further analysis reveals that HSR-NMF discovers interpretable topological structures, providing a policy-agnostic hierarchical map that effectively bridges model-free optimality and model-based flexibility. Beyond providing a useful basis for task-transfer, we show that HSR's temporally extended predictive structure can also be leveraged to drive efficient exploration, effectively scaling to large, procedurally generated environments.
arXiv:2606.15436v1 Announce Type: cross Abstract: Respiratory acoustic foundation models (FMs) excel at cough classification, yet their ability to predict continuous health quantities from cough audio remains largely unexplored, despite the clinical value of passive age, BMI, and disease probability estimation in settings where physical measurements are unavailable. We introduce the multi-model, multi-target cough regression benchmark evaluating five FMs (OPERA-CT, OPERA-CE, OPERA-GT, HeAR, M2D+Resp) across six targets on three datasets under subject-disjoint protocols, comparing linear, MLP-small, and full MLP regression heads. MLP-small beats the mean-predictor baseline on all tasks and linear probing in 23 of 30 model x task cases, with full MLP overfitting on small clinical data but recovering on larger sets, revealing a dataset size x head-capacity trade-off. HeAR leads within-dataset age regression on Coswara (9.12 yr MAE); its CIDRZ result is excluded from headline claims owing to possible HeAR-CIDRZ pretraining overlap. OPERA-GT is favored over OPERA-CT on age in all three datasets, with the CIDRZ margin within seed variance, extending a generative-pretraining advantage from breath to cough. HeAR and M2D+Resp reach near-full performance at N = 50 samples while OPERA models require N = 400. Cross-dataset transfer is strongly asymmetric as large diverse data generalises to small clinical populations (CoughVID to CIDRZ: -0.17 yr) but not vice versa (CIDRZ to Coswara: +2.43 yr, +26.6%).
Every molecule ever synthesised can be drawn as a 2D skeletal diagram, yet in modern property prediction this universally available representation has received less focus in favour of molecular graphs, 3D conformers, or billion-parameter language models, each imposing its own computational and data-engineering overhead. We present $MolSight$, the first systematic large-scale study of vision-based Molecular Property Prediction (MPP). Using 10 vision architectures, 7 pre-training strategies, and $2\,M$ molecule images, we evaluate performance across 10 downstream tasks spanning physical-property regression, drug-discovery classification, and quantum-chemistry prediction. To account for the wide variation in structural complexity across pre-training molecules, we further propose a $chemistry-informed curriculum$: five structural complexity descriptors partition the corpus into five tiers of increasing chemical difficulty, consistently outperforming non-curriculum baselines. We show that a single rendered bond-line image, processed by a vision encoder, is sufficient for competitive molecular property prediction, i.e. $chemical insight from sight alone$. The best curriculum-trained configuration achieves the top result on $5 of 10$ benchmarks and top two on $all 10$, at $$80$\times$ lower$$ FLOPs than the nearest multi-modal competitor.
Text and 2D-conditioning interfaces provide weak, ambiguous control over spatial transformations in image editing – particularly under large object motions and camera changes. Prior work has used 3D primitives such as boxes, but only as loose conditioning signals indicating approximate object location rather than specifying the transformation. We instead use 3D boxes as structured specifications: the user provides the input and output boxes of the edit, casting editing as a well-posed geometry problem. This ``thinking in boxes'' interface, where each box face is color-coded to convey 3D orientation, gives precise control over translation, rotation, scaling, and viewpoint changes in real images while preserving scene and object identity, and recovering previously unseen object regions. To ground transformations in scene appearance, we introduce a depth-aligned planar floor as a global reference frame, shaded with depth-aware cues. Conditioned on this structure, an image generator produces consistent results under large transformations. Trained in two stages – on synthetic multi-object scenes and a small set of real-world videos from Objectron – the system generalizes to complex, in-the-wild real images. Our method operates directly on real photographs and substantially outperforms recent state-of-the-art methods on large 3D edits.
arXiv:2606.13720v1 Announce Type: new Abstract: Arditi et al. (2024) has shown that refusal in safety fine-tuned chat models is mediated by a single linear direction in the residual stream, recoverable by a difference-in-means (DiM) of harmful and harmless activations. We compare DiM-based interventions (activation addition and directional ablation) with two interventions derived from Iterative Nullspace Projection (INLP) – nullspace projection and counterfactual flipping – on five open-weight chat models, asking whether INLP can match DiM at steering refusal and whether its richer parameterisation yields more tweakable interventions. INLP counterfactual flipping is competitive with DiM directional ablation on refusal suppression, while nullspace projection is consistently weaker. Restricting INLP to the leading directions of the extracted subspace preserves most of the suppression effect at near-baseline perplexity, giving a tunable capability. Geometrically, the two INLP interventions land in qualitatively different regions of activation space: nullspace projection collapses transformed activations between the harmful and harmless clusters, while counterfactual flipping moves them into the opposite cluster, suggesting that the model encodes the absence of a concept differently from its opposite – an intriguing distinction that warrants further investigation in future work.
Industrial products such as valves and circuit breakers are defined by dense technical specifications that govern procurement, compatibility, and safety across supply chains. These specifications are scattered across multiple heterogeneous product images, including specification tables, nameplates, and technical drawings, yet whether Multimodal Large Language Models (MLLMs) can reliably recover them remains underexplored. To fill this gap, we introduce IndustryBench-MIPU, the first large-scale benchmark for multi-image industrial product understanding, built around structured attribute extraction – recovering property-value pairs from product images. This task jointly probes text recognition on specification tables and nameplates, visual reasoning over technical drawings, domain knowledge to decode industrial terminology, and cross-image evidence integration to assemble scattered specifications. Concretely, the benchmark comprises 4,559 products across 27,652 images with 103,703 annotations spanning 18 industrial categories, constructed through multi-model consensus and three-tier quality assurance. Evaluating nine MLLMs under both single-image and product-level multi-image settings reveals a stark completeness gap: models achieve high precision (86–94%) but the best recovers only 49.9% of product-level attributes; moving from single-image to multi-image extraction costs 15–34 percentage points of recall. Multi-image completeness, not single-image accuracy, is the core bottleneck. Dataset and code are publicly available.
arXiv:2606.13978v1 Announce Type: cross Abstract: This paper evaluates a signal-processing and supervised-learning pipeline for classifying SDSS DR17 astronomical spectra into stars, galaxies, and quasars. Each spectrum is represented by its measured flux and inverse-variance information, combining spectral shape with a wavelength-dependent reliability profile. After resampling onto a common logarithmic wavelength grid, the flux and inverse-variance vectors are standardized and separately compressed using principal component analysis. The resulting components are concatenated and used to train several classifiers. The best performance was obtained with the LightGBM gradient-boosting classifier, reaching $94.6\%$ accuracy and $92.1\%$ balanced accuracy on the test set.
Concept Bottleneck Models (CBMs) are a relevant tool for explainable Artificial Intelligence because they make their predictions through human-interpretable symbols. However, high task accuracy does not guarantee that these symbols are detected faithfully: jointly trained CBMs may encode task-specific shortcuts in the bottleneck, making their explanations unreliable. In this paper, we study concept-detection reliability by swapping independently trained concept detectors and classification heads that share the same symbolic vocabulary. We use the resulting performance degradation, concept-level metrics, and symbol-wise uncertainty estimates to identify concepts that are especially prone to spurious firing. Finally, we propose a reliability-aware training strategy in which a shared concept detector is optimized with multiple classification heads and penalized for relying on globally or instance-wise unreliable symbols. On CUB-200-2011 with full concept supervision, detectors and heads are almost freely interchangeable (swap drop below one accuracy point, relative retention above $99\%$, and no concept detected below chance), whereas on a controlled synthetic task we show that, as the concept-supervision weight is reduced, models keep near-perfect task accuracy while swapped accuracy and agreement with the ground-truth concepts collapse to chance. Our reliability-aware training substantially mitigates this leakage, roughly doubling swap accuracy in the leaky regime.
Background: Endometrial cancer incidence and mortality are increasing, particularly among Black women and for aggressive subtypes. Allostatic load (AL), a composite measure of physiologic dysregulation across metabolic, cardiovascular, and immune systems, varies by racial category and tumor subtype in other cancers. Endometrial cancer is strongly associated with obesity, and it is unknown whether AL scores maintain sufficient heterogeneity to evaluate differences across subgroups or with clinical outcomes. Objective: To describe the performance of AL scoring in endometrial cancer patients and examine associations with tumor characteristics (grade/histology) and survival outcomes. Methods: We evaluated AL among 398 participants newly diagnosed with endometrial cancer. AL score was calculated by assigning 1 point for each ''high-risk'' value (by clinical reference range or distribution-based) for 15 biologic variables for vital signs, anthropometrics, blood-based biomarkers, and medical comorbidities. Results: Distribution-based thresholds for variables were used to preserve heterogeneity in this obesity-dominant context. Overall, 68.7% of Black women had high AL compared to White (56.7%), Hispanic (56.7%), and other race (32.3%) women. Decision tree analyses revealed grade-dependent associations between AL and survival. For women with low-grade tumors, higher AL was associated with poorer overall survival. For high-grade tumors, intermediate AL ([≥]4,