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ObjectiveImmature teratomas are rare malignant ovarian germ cell tumours, typically diagnosed in young women, where fertility-sparing surgery is the treatment of choice. The role of adjuvant chemotherapy in stage I disease remains controversial. We evaluated the impact of surveillance versus chemotherapy on the recurrence rate in stage I immature teratomas.MethodsWe collected a single centre retrospective series of patients with stage I immature teratomas treated with fertility-sparing surgery at San Gerardo Hospital, Monza, Italy, between 1980 and 2019. Potential risk factors for recurrence were investigated by multivariate logistic regression.ResultsOf the 74 patients included, 12% (9/74) received chemotherapy, while 88% (65/74) underwent surveillance. Median follow-up was 188 months. No difference in recurrence was found in stage IA/IB and IC immature teratomas [10% (6/60) vs. 28.6% (4/14) (P=0.087)], grade 1, grade 2, and grade 3 [7.1% (2/28) vs. 14.3% (4/28) vs. 22.2% (4/18) (p=0.39)], and surveillance versus chemotherapy groups [13.9% (9/65) vs. 11.1% (1/9)) (p = 1.00)]. In univariate analysis, the postoperative approach had no impact on recurrence. The 5-year disease-free survival was 87% and 90% in the surveillance and chemotherapy groups, respectively; the overall survival was 100% in both cohorts.ConclusionsOur results support the feasibility of surveillance in stage I immature teratomas. Adjuvant chemotherapy may be reserved for relapses. However, the potential benefit of chemotherapy should be discussed, especially for high-risk tumours. Prospective series are warranted to confirm our findings.What is already known on this topicTo date, no consensus has been reached regarding the role of adjuvant chemotherapy in stage I immature teratomas of the ovary. Some studies suggest that only surveillance is an acceptable choice. However, guidelines are not conclusive on this topic.What this study addsNo difference in terms of recurrence was observed between the surveillance and the adjuvant chemotherapy group. All patients who relapsed were successfully cured with no disease-related deaths.How this study might affect research, practice or policyAdjuvant chemotherapy should be appropriately discussed with patients. However, it may be reserved for relapse according to our data.

Kepler-51 is a ≲1 Gyr old Sun-like star hosting three transiting planets with radii ≈6–9 R _⊕ and orbital periods ≈45–130 days. Transit timing variations (TTVs) measured with past Kepler and Hubble Space Telescope (HST) observations have been successfully modeled by considering gravitational interactions between the three transiting planets, yielding low masses and low mean densities (≲0.1 g cm ^−3 ) for all three planets. However, the transit time of the outermost transiting planet Kepler-51d recently measured by the James Webb Space Telescope 10 yr after the Kepler observations is significantly discrepant from the prediction made by the three-planet TTV model, which we confirmed with ground-based and follow-up HST observations. We show that the departure from the three-planet model is explained by including a fourth outer planet, Kepler-51e, in the TTV model. A wide range of masses (≲ M _Jup ) and orbital periods (≲10 yr) are possible for Kepler-51e. Nevertheless, all the coplanar solutions found from our brute-force search imply masses ≲10 M _⊕ for the inner transiting planets. Thus, their densities remain low, though with larger uncertainties than previously estimated. Unlike other possible solutions, the one in which Kepler-51e is around the 2:1 mean motion resonance with Kepler-51d implies low orbital eccentricities (≲0.05) and comparable masses (∼5 M _⊕ ) for all four planets, as is seen in other compact multiplanet systems. This work demonstrates the importance of long-term follow-up of TTV systems for probing longer-period planets in a system.

The effect of stellar multiplicity on planetary architecture and orbital dynamics provides an important context for exoplanet demographics. We present a volume-limited catalog of up to 300 pc of 66 stars hosting planets and planet candidates from Kepler, K2, and TESS with significant Hipparcos-Gaia proper motion anomalies, which indicates the presence of companions. We assess the reliability of each transiting planet candidate using ground-based follow-up observations, and find that the TESS Objects of Interest (TOIs) with significant proper anomalies show nearly four times more false positives due to eclipsing binaries compared to TOIs with marginal proper anomalies. In addition, we find tentative evidence that orbital periods of planets orbiting TOIs with significant proper anomalies are shorter than those orbiting TOIs without significant proper anomalies, consistent with the scenario that stellar companions can truncate planet-forming disks. Furthermore, TOIs with significant proper anomalies exhibit lower Gaia differential velocities in comparison to field stars with significant proper anomalies, suggesting that planets are more likely to form in binary systems with low-mass substellar companions or stellar companions at wider separation. Finally, we characterize the three-dimensional architecture of LTT 1445 ABC using radial velocities, absolute astrometry from Gaia and Hipparcos, and relative astrometry from imaging. Our analysis reveals that LTT 1445 is a nearly flat system, with a mutual inclination of ∼2.°88 between the orbit of BC around A and that of C around B. This coplanarity may explain why multiple planets around LTT 1445 A survive in the dynamically hostile environments of this system.