A Registry-Informed Framework for Earlier Detection of Esophageal Adenocarcinoma in Thailand: Evidence from a 16-Year Cohort Study

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.