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Objective: To study the prognostic factors determining survival of esophageal cancer with distant organ metastasis at initial diagnosis as to determinate the optimal therapy of these patients.Methods: 58 evaluable patients of esophageal cancer with distant organ metastasis at initial diagnosis were studied retrospectively.The survival rate was calculated by Kaplan-Meier, log-rank test was used to test the differences of survival rate.Multivariable analysis was performed using the Cox proportion hazards model.Results: The median survival time was 6.5 months (1-55), and the 1, 2-year survival rate were 20.7%,11.6% respectively in all patients.The median survival time of patients with single-metastasis is 10 months and the 1-year,2-year survival rate are 47.4% and 28.1%, while in the multi-metastasis are 5 months, 7.7% and 3.8%(p<0.001).The 1-,2-year survival rate with multimodality treatment are 70% and 45% respectively, which are significant better than chemotherapy alone(12.9% and 8.6%, p=0.003)and best supportive care(5.9% and 0%, p<0.001),but there is no significant difference between the latter two groups(p=0.052).Conclusions: For patients of esophageal cancer with distant organ metastasis at initial diagnosis,single-metastasis is favoring overall survival;multimodality treatment may improve survival while chemotherapy alone is not established.