Abstract: Objective To determine the key factors favorable for good prognosis by comparing clinicopathological differences between ultra-long (≥10 years, ULS) and short-term survival (<5 years,SS) in esophageal cancer (EC). Methods Home interview and questionnaire were performed in a large-scale mass survey in high-incidence area for EC in He'nan, China. The database of ULS patients was established based on the retrieved clinicopathological information from medical records in The First Affiliated Hospital of Zhengzhou University.Chi-square test and multi-factor logistic model regression were applied for survival analyzed by SPSS19.0 software. Results A total of 4008 patients with EC??including 2019 case with ULS and 1989 case with SS were fi nally enrolled. Compared with SS patients, the mean age at diagnosis of ULS patients was younger (male, 53±8.7 vs.61±8.8; female, 54±8.4 vs. 61±8.8, P<0.05), the ratio of ULS patients in middle and advanced stage was lower (87% vs.96%, χ2 =69.09, P<0.05), the ratio of ULS patients in early stage was 3-folds higher (13% vs.4%, χ2=69.09，P<0.05), the ratio of ULS patients with well-differentiated was 2-folds higher (31% vs.13%, χ2=191. 56, P<0.05), and the ratio of ULS patients with lymph node metastasis was 2-folds lower (23% vs.53%,χ2=223.40,P<0.05). Moreover, T2 stage in ULS patients while T3 stage in SS patients was prominent(47% vs.64%, χ2=228.57,P<0.05). In addition, ULS patients had a higher frequency of family history (40% vs.28%, χ2=43.25, P<0.05) and surgical treatment (80% vs.69%, χ2=72.94，P<0.05). Conclusion Differentiated degree and infiltration depth of esophageal cancer cells, lymph node metastasis, family history and different treatments were the important factors for prognosis of esophageal cancer.The key favorable factors for ULS patients were well-differentiated status, no lymph node metastasis, positive family history and early onset age.