Patcharipa Chanaturakarnnon

Esophageal cancer is frequently diagnosed at an advanced stage, limiting opportunities for curative treatment and contributing to poor clinical outcomes. We aimed to identify clinicopathological predictors of advanced-stage presentation and use these findings to inform a registry-informed framework for earlier detection of esophageal adenocarcinoma (AC) in Thailand. A retrospective cohort study was conducted using the Siriraj Cancer Registry. Among 1451 patients diagnosed with esophageal cancer between 2009 and 2024, 591 patients with sufficient clinical and/or pathological information for stage assignment were included. Patients were classified as having early-stage (Stage I–II) or advanced-stage (Stage III–IV) disease. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of advanced-stage presentation. Among patients with sufficient information for reliable stage assignment, 77.5% presented with advanced-stage disease. AC histology was independently associated with increased odds of advanced-stage presentation compared with squamous cell carcinoma (adjusted odds ratio 4.16, 95% confidence interval 1.21–14.30; p = 0.024). A trend toward earlier-stage diagnosis was observed during 2017–2024 compared with 2009–2016 (adjusted odds ratio 0.66, 95% confidence interval 0.43–1.00; p = 0.052). These findings provide hypothesis-generating evidence to inform a risk-based approach to earlier evaluation of individuals at increased risk of esophageal AC in Thailand, which requires prospective validation.