Utility of Ki-67 index combined with alpha-fetoprotein and lactate dehydrogenase in distinguishing mature from immature ovarian teratomas in children.
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BACKGROUND: Accurate differentiation between mature and immature ovarian teratomas in children remains a diagnostic challenge. Current histopathological grading is subjective, and reliable preoperative biomarkers are lacking. This study aimed to evaluate the diagnostic and prognostic value of Ki-67, alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH), individually and in combination. METHODS: We retrospectively analyzed 82 pediatric patients (≤18 years) with histologically confirmed ovarian teratomas, including 45 mature and 37 immature cases. Serum AFP and LDH levels and Ki-67 proliferation indices were compared between groups. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify independent predictors and assess diagnostic performance. Recurrence-free survival (RFS) was evaluated using Kaplan-Meier and Cox regression analyses. RESULTS: AFP, LDH, and Ki-67 levels were significantly higher in the immature group than in the mature group (all p < 0.001). Ki-67 expression increased progressively with higher pathological grades (P for trend < 0.001). In multivariate analysis, Ki-67 > 30% (OR 7.16, 95% CI 3.09-16.58), AFP > 500 ng/mL (OR 5.42, 95% CI 2.31-12.75), and LDH > 300 U/L (OR 3.04, 95% CI 1.32-6.98) were independent predictors of immaturity. The combined model (AFP + LDH + Ki-67) achieved the highest diagnostic accuracy (AUC = 0.96), outperforming any single marker (p < 0.05). During a median follow-up of 38 months, recurrence occurred in 8 patients (10.3%), all with immature teratomas. High Ki-67 expression (>30%) was independently associated with shorter RFS (HR = 4.62, 95% CI 1.48-14.46, p = 0.009). CONCLUSION: The combined assessment of Ki-67, AFP, and LDH provides a robust biomarker panel for differentiating immature from mature ovarian teratomas in children and predicting recurrence risk. Integration of proliferative and metabolic indicators into pathological evaluation may enhance diagnostic precision and support individualized management in pediatric ovarian germ cell tumors.