ETCS has a nice category-theoretic formulation: "well-pointed topos with a natural numbers object and axiom of choice."
I'm too new to topoi to really understand all of what's going on, but I read that ETCS is weaker than ZFC and is missing the axiom of replacement. However, ETCS+R is the same strength as ZFC.
Maybe this is really just a question about aesthetics. Is there a nice category-theoretic way to express replacement?
You'll likely be interested in a discussion about replacement that happened in the category theory mailing list a few years ago. You can find it here. Just grep for "replacement" and you'll get to the right area in the email chain.
In particular, you'll likely be interested in Mike Shulman's question
which Colin McLarty answers as follows (minor mathjax related edits are mine):
The "early published proof" he's referring to is Gerhard Osius's Logical and Set Theoretical Tools in Elementary Topoi. Later in the same email, he mentions his own paper Exploring Categorical Structuralism as a good reference for details on replacement (rather than reflection, as discussed in Osius's paper).
Even though I copied the relevant section here, there are many other interesting tidbits about replacement and other aspects of categorical set theory that you're likely to be interested in scattered throughout that email thread (it's also linked from the nlab page on replacement, which you might also be interested in). It's definitely worth a read!
I hope this helps ^_^