# A decade of esophageal cancer in Kazakhstan: what the national cancer registry reveals (2014–2023)

## TL;DR

This study reveals a significant rise in esophageal cancer mortality in Kazakhstan over ten years, highlighting the need for better early detection and treatment access.

## Contribution

The study provides the first comprehensive national analysis of esophageal cancer trends and survival in Kazakhstan from 2014 to 2023.

## Key findings

- Esophageal cancer mortality in Kazakhstan tripled from 4.4 to 10.6 per 100,000 between 2014 and 2023.
- Three-year survival dropped from 62.9% at Stage I to 12.9% at Stage IV, with advanced stage being a major predictor of poor outcomes.
- Kyzylorda and Karaganda regions had the highest disease burden, and early-onset cases showed a tripling of DALYs over ten years.

## Abstract

Esophageal cancer (EC) is a major yet understudied public health burden in Central Asia. Kazakhstan has one of the highest EC rates in the region, but national epidemiological trends and survival outcomes remain poorly reported. Epidemiological trends among younger adults are largely unexplored, despite growing concern about early-onset gastrointestinal cancers. This study assessed recent patterns in EC incidence, mortality, disease burden, and survival across Kazakhstan from 2014 to 2023.

We conducted a retrospective, population-based cohort study including all EC patients registered in the National Cancer Registry between Jan 1, 2014, and Dec 31, 2023. Demographic, clinical, and survival data were extracted from registry-linked records. Early-onset EC was defined as diagnosis before age 45. Age-standardized incidence, mortality, and prevalence rates per 100,000 were calculated using the WHO World Standard Population. DALYs were estimated following GBD 2023 methodology. Survival was assessed using Kaplan–Meier methods; predictors were analyzed with Cox regression.

The cohort included 24,778 patients. The age-standardized incidence rate was 13.9 per 100,000 (95% CI 12.6–15.1). Mortality rose from 4.4 per 100,000 in 2014 to 10.6 per 100,000 in 2023, peaking at 12.3 per 100,000 in 2018. DALYs increased from 3,383 (95% UI 2,970–3,800) to 8,300 (95% UI 6,691–9,269) per 100,000, 95% attributable to YLL. In early-onset cases, DALYs per 100,000 tripled over ten years. Three-year survival declined from 62.9% (95% CI 59.2–66.6) at Stage I to 12.9% (95% CI 10.8–15.0) at Stage IV. Male sex (aHR 1.11), advanced stage (aHR 7.10), and alcohol disorders (aHR 1.15) were associated with poorer survival. Kyzylorda and Karaganda regions had the highest burden.

Despite stable incidence, EC mortality in Kazakhstan has tripled over the past decade, reflecting late-stage diagnosis, limited treatment access, and persistent modifiable risk factors such as alcohol and tobacco use. These findings highlight a critical public health gap and underscore the need for early detection programs and strengthened oncology infrastructure to reduce premature mortality in Kazakhstan and neighboring countries.