LungCURE: Benchmarking Multimodal Real-World Clinical Reasoning for Precision Lung Cancer Diagnosis and Treatment

Abstract: Lung cancer clinical decision support demands precise reasoning across complex, multi-stage oncological workflows. Existing multimodal LLMs (MLLMs) fail to handle guideline-constrained staging and treatment reasoning. We formalize three oncological precision treatment (OPT) tasks for lung cancer, spanning TNM staging, treatment recommendation, and end-to-end clinical decision support. We introduce LungCURE, the first standardized multimodal benchmark built from 1,000 real-world, clinician-labeled cases across more than 10 hospitals. We further propose LCAgent, a multi-agent framework that ensures guideline-compliant lung cancer clinical decision-making by suppressing cascading reasoning errors across the clinical pathway. Experiments reveal large differences across various LLMs in their capabilities for complex medical reasoning, when given precise treatment requirements. We further verify that LCAgent, as a simple yet effective plugin, enhances the reasoning performance of LLMs in real-world medical scenarios.