Many studies have shown the associations of alterations in four established driver genes (KRAS, TP53, CDKN2A, SMAD4) with clinical outcomes of resected PAAD patients4,20,31, whereas there seems to be no consensus about the well-defined concurrent mutations of driver genes (e.g. KRAS G12D and TP53 co-mutations) as prognostic biomarkers for stage-specific patients and it could be expanded by our observations. Here, SMAD4 is linked to pancreatic adenocarcinoma.