In some recent studies, some gene alterations (KRAS, TP53, CDKN2A and SMAD4) have been shown to be associated with the OS of pancreatic cancer patients [26], but the proportion of pancreatic cancer patients with mutations in at least one of these four genes was found to be less than 40%[27]. This evidence concerns the gene SMAD4 and familial pancreatic carcinoma.