Abstract:  Abstract　Objective: To discuss the effect of supraclavicular lymph node metastasis on the M classification of esophageal carcinoma, and to analyze the factors that affect the prognosis of esophageal carcinoma after radiotherapy. Methods: Data from esophageal carcinoma patients with supraclavicular lymph node metastases who were admitted to The Fourth Hospital of Hebei Medical University from January 2005 to December 2009 were collected. There were 152 patients in the current retrospective study. A total of 95 patients with primary tumors received radiotherapy, whereas 57 underwent surgery. Supraclavicular lymph node metastasis was found in 81 cases after the treatment for primary esophageal carcinoma. Of the 81 cases, metastasis was found in 71 upon initial diagnosis. A total of 141 patients with supraclavicular lymph-node metastasis received radiotherapy, whereas 11 did not. Results: Follow-ups for all patients were done 2 to 68 months after release, with a median follow-up time of 17 months. After radiotherapy for the supraclavicular lymph node, 74 patients had complete remission, 59 had partial remission, 5 had no change, and 3 patients had progressive disease. Until the end of the follow-up, 40 of the 81 patients survived. The 1-, 2-, and 3-year overall survival ( OS ) rates were 69.1%, 37.4%, and 24.0%, respectively. Multivariate analysis revealed that age, time of supraclavicular lymph-node metastasis, the presence of unilateral or bilateral nodal metastasis, and the therapeutic effect of the enlarged lymph nodes and visceral metastasis were independent factors for the survivals ( P < 0.05 ). The regional nodal metastasis and supraclavicular lymph node metastasis were found in 39 ( N group ) and 71 ( M group ) patients, respectively, when the primary esophageal carcinoma was diagnosed. The 1-, 2-, and 3-year survival rates of the N group were 82.1%, 54.1%, and 31.0%, respectively, and 56.3%, 28.1%, and 21.7% for the M group, respectively ( P = 0.041 ). The M group was divided into groups M1a and M1b. The 1-, 2-, and 3-year survival rates were 60.0%, 27.3%, and 27.3% for M1a, and 54.9%, 28.7%, and 19.0% for M1b, respectively ( P = 0.930 ). Based on the 6th edition of esophageal cancer staging, visceral metastasis was found in 48 cases during or after supraclavicular nodal metastasis was observed, whereas nodal metastasis was not found in the other 104 cases. The 1-, 2-, and 3-year survival rates were 62.5%, 17.5%, and 5.8% for the group with nodal metastasis and 72.1%, 47.0%, and 32.9% for the group without nodal metastasis, respectively ( P < 0.001 ). Conclusion:  Esophageal carcinoma patients with supraclavicular lymph node metastasis, regional nodal metastasis, and visceral metastasis have different survival rates. Differences were evident in the prognosis of patients with simple metastasis to the supraclavicular lymph nodes and those with combined metastasis in internal organs. Further studies are warranted on whether supraclavicular lymph node enlargement, based on its staging, should be considered as distant metastasis. The survival rates of patients with upper, middle, and inferior esophageal carcinoma were not significantly different. Age, time of supraclavicular lymph node enlargement with primary esophageal carcinoma, unilateral or bilateral supraclavicular lymph node metastasis, the short-term curative effect of enlarged lymph nodes, and visceral metastasis are independent factors for patient survival.