Among them, high versus low/no mutation of KRAS, TP53, CDKN2A, or SMAD4 in tumor was not significantly associated with OS or PFS; however, compared with low/no mutation, high mutation of KRAS (OS, P = 0.009; PFS, P = 0.001), TP53 (OS, P = 0.033; PFS, P = 0.003), CDKN2A (PFS, P = 0.001), or SMAD4 (OS, P < 0.001; PFS, P = 0.015) in ctDNA was significantly linked to better survival (Fig. 7), suggesting greater predictive values of ctDNA mutations for such patients. Here, SMAD4 is linked to neoplasm.