Trx1-CA125 strategy matches ROMA with higher ovarian cancer sensitivity

An exploratory clinical diagnostic study found that a dual-marker strategy combining serum thioredoxin-1 (Trx1) and cancer antigen 125 (CA125) achieved higher reported sensitivity for ovarian cancer than the Risk of Ovarian Malignancy Algorithm (ROMA), while producing similar overall diagnostic discrimination. Researchers measured CA125, human epididymis protein 4 (HE4) and Trx1 in 80 patients with ovarian cancer and 297 controls. The Trx1-CA125 combination, called the Dual-marker Ovarian Cancer Risk Algorithm (DORA), had an area under the receiver operating characteristic curve (AUC) of 0.864, compared with 0.853 for ROMA.

Among the individual biomarkers, CA125 had the highest overall diagnostic performance, with an AUC of 0.832. HE4 followed with an AUC of 0.812, while Trx1 reached 0.768. The comparison of DORA with ROMA was therefore not a finding that either marker alone outperformed the established algorithm.

The investigators also assessed whether Trx1 concentrations were associated with age or menopausal status and found only minimal associations. They analyzed the influence of age, menopausal status, obstetric history, pathological characteristics and cancer stage on biomarker performance. Differences were also reported in two clinically defined subgroups.

Among premenopausal women, DORA had a sensitivity of 76.2%, compared with 42.9% for ROMA. Among patients with early-stage ovarian cancer, DORA had a sensitivity of 82.2%, while ROMA sensitivities ranged from 36.8% to 46.2% in the reported analyses. These subgroup estimates came from the same exploratory cohort of 80 ovarian cancer patients and 297 controls.

The work is characterized as an exploratory diagnostic-accuracy study, and its population consisted of 80 ovarian cancer patients and 297 controls. Diagnostic performance was evaluated with ROC curve analysis, including AUC, sensitivity and specificity estimates for individual biomarkers and their combinations, with comparisons conducted across premenopausal and postmenopausal subgroups. The supplied results do not provide the numerical specificity value for DORA, nor do they report every threshold-specific comparison between the biomarkers.

The central result is narrower: in this cohort, adding Trx1 to CA125 produced higher reported sensitivity than ROMA overall, in premenopausal women and in early-stage ovarian cancer, while the two approaches had similar AUC values.

Subject of Research: Clinical diagnostic accuracy of a dual Trx1-CA125 biomarker strategy for ovarian cancer

Article Title: Towards a universal ovarian cancer biomarker model: clinical validation of Trx1 and CA125 dual strategy

Article References: Park, M. A., Kim, S., Yang, X., Song, J. A., Lee, G. W., Yoo, H. J., Kim, S., Suh, K. H., & Ko, Y. B. (2026). Towards a universal ovarian cancer biomarker model: clinical validation of Trx1 and CA125 dual strategy. BMC Cancer. https://doi.org/10.1186/s12885-026-16887-2

Image Credits: AI Generated

DOI: 10.1186/s12885-026-16887-2

Keywords: ovarian cancer, Trx1, CA125, HE4, ROMA, DORA, diagnostic accuracy, biomarkers, sensitivity, early-stage cancer, premenopausal women, Towards