SMAD4 and metastatic malignant neoplasm in the lymph nodes: (22): 11 points for a high rad-score, nine points for four to six cycles of adjuvant chemotherapy, seven points for low differentiation, six points for ≥80% decrease in ΔCA19-9, five points for <two cycles of adjuvant chemotherapy, three points for positive LVI, three points for lymph node metastasis, and one point for positive SMAD4 expression.