A Multiparty Homomorphic Encryption Approach to Confidential Federated Kaplan Meier Survival Analysis

The proliferation of healthcare data has expanded opportunities for collaborative research, yet stringent privacy regulations hinder pooling sensitive patient records. We propose a \emph{multiparty homomorphic encryption-based} framework for \emph{privacy-preserving federated Kaplan--Meier survival analysis}, offering native floating-point support, a theoretical model, and explicit reconstruction-attack mitigation. Compared to prior work, our framework ensures encrypted federated survival estimates closely match centralized outcomes, supported by formal utility-loss bounds that demonstrate convergence as aggregation and decryption noise diminish. Extensive experiments on the NCCTG Lung Cancer and synthetic Breast Cancer datasets confirm low \emph{mean absolute error (MAE)} and \emph{root mean squared error (RMSE)}, indicating negligible deviations between encrypted and non-encrypted survival curves. Log-rank and numerical accuracy tests reveal \emph{no significant difference} between federated encrypted and non-encrypted analyses, preserving statistical validity. A reconstruction-attack evaluation shows smaller federations (2--3 providers) with overlapping data between the institutions are vulnerable, a challenge mitigated by multiparty encryption. Larger federations (5--50 sites) degrade reconstruction accuracy further, with encryption improving confidentiality. Despite an 8--19$\times$ computational overhead, threshold-based homomorphic encryption is \emph{feasible for moderate-scale deployments}, balancing security and runtime. By providing robust privacy guarantees alongside high-fidelity survival estimates, our framework advances the state-of-the art in secure multi-institutional survival analysis.