Survival analysis plays a crucial role in understanding time-to-event (survival) outcomes such as disease progression. Despite recent advancements in causal mediation frameworks for survival analysis, existing methods are typically based on Cox regression and primarily focus on a single exposure or individual omics layers, often overlooking multi-omics interplay. This limitation hinders the full potential of integrated biological insights. In this paper, we propose SMAHP, a novel method for survival mediation analysis that simultaneously handles high-dimensional exposures and mediators, integrates multi-omics data, and offers a robust statistical framework for identifying causal pathways on survival outcomes. This is one of the first attempts to introduce the accelerated failure time (AFT) model within a multi-omics causal mediation framework for survival outcomes. Through simulations across multiple scenarios, we demonstrate that SMAHP achieves high statistical power, while effectively controlling false discovery rate (FDR), compared with two other approaches. We further apply SMAHP to the largest head-and-neck carcinoma proteogenomic data, detecting a gene mediated by a protein that influences survival time.

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