Abstract: Objective To investigate the relationship between tumor length (TL) and invasion (T-stage) and lymph node metastasis and survival in esophageal squamous cell carcinoma (ESCC) patients. Methods The questionnaire, home interview and / or telephone were performed for follow-up. The Chi-square test, Nonparametric test, Spearman Correlation, Kaplan-Meier survival analysis and multivariate Cox regression model were applied to assess the association between TL, invasion and lymph node metastasis and survival of ESCC in high-incidence areas of Tai-hang from 1995 to 2011. Results (1) With the infi ltration increasing, the largest diameter of tumor enhanced (P <0.001); lymph node metastasis in patients with maximum tumor diameter <3 cm was signifi cantly lower than that in patients ≥3 cm (P <0.001); tumor maximum diameter and depth of invasion were positively correlated to lymph node metastasis (RT=0.379, RN=0.213, P <0.001); (2) Overall survival in maximum tumor diameter ≥3 cm was signifi cantly shorter than that in <3 cm (P <0.001). Multivariate analysis showed that maximum tumor diameter, gender, age at diagnosis, extent of invasion, lymph node metastasis, gross type, degree of differentiation, tumor location were independent factors affecting survival (P <0.05). Conclusion Tumor length was an independent prognostic factor for survival time of ESCC patients.