High Ki-67 expression (>30%) was independently associated with shorter RFS (HR = 4.62, 95% CI 1.48-14.46, <i>p</i> = 0.009).<h4>Conclusion</h4>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. This evidence concerns the gene MKI67 and ovarian teratoma.