GeneICL: A Tabular Foundation Model for Bulk Transcriptomics

Gene expression is widely measured in biomedicine, yet clinical outcome prediction remains challenging due to high dimensionality, strong feature correlations, and limited labeled data. Large self-supervised transcriptomic foundation models often fail to outperform simple supervised baselines. Tabular foundation models offer an alternative through in-context learning, but are typically pretrained on generic synthetic data rather than transcriptomic structure. We ask whether transcriptomics-aware pretraining, rather than scale, is the missing ingredient. Towards this end, we introduce GeneICL, a 4.2M-parameter tabular foundation model combining a semi-synthetic pretraining prior built from measured bulk expression profiles with a parameter-efficient recurrent architecture. We further enable right-censored survival prediction via a training-free reduction to regression using Cox partial-likelihood residuals. We evaluate GeneICL on 80 clinical outcome-prediction tasks spanning classification, regression, and survival. Tabular foundation models consistently outperform self-supervised transcriptomic models, while GeneICL achieves the best overall rank among evaluated foundation models and tuned baselines. GeneICL does so with up to 387$\times$ fewer parameters, no gradient updates at inference, and predictions within seconds on a laptop CPU.