Abstract: Objective : To determine the factors influencing prognosis of patients with primary esophageal adenocarcinoma and to discuss the difference between esophageal adenocarcinoma and esophageal squamous carcinoma. Methods : The data of 42 cases with esophageal adenocarcinoma treated with surgery were studied retrospectively and were compared with 1938 cases of esophageal squamous carcinoma treated by surgery. SPSS software was used to elucidate the factors influencing the prognosis of patients with these diseases. Results : Of the patients with esophageal adenocarcinoma, the male/female ratio was 4.3:1, the median age was 61, the average course was 4 months and the average length of tumors was 5 cm. The rate of resection and mortality was 88.1% and 7.1%, respectively. The 1-, 3- and 5-year postoperative survival rate of the cases was 69.0%, 35.7% and 16.7%, respectively. Conclusion : The clinical features of primary esophageal adenocarcinoma are similar to those of esophageal squamous carcinoma, and the rate of lymph node metastasis for esophageal adenocarcinoma is high. The prognosis for patients with primary esophageal adenocarcinoma depends on the pathological staging, infiltration and lymph node metastasis. The main means to improve prognosis are early detection, early diagnosis and early standardized radical surgery, as well as combined therapy.