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Objective To explore the prognostic factors that affect patients with advanced esophageal cancer treated with Traditional Chinese medicine (TCM). Methods A total of 72 patients with stage IV esophageal cancer were selected for analysis, and the advantaged and disadvantaged groups of TCM treatment were defined according to survival time. The log-rank method was used for the univariate analysis, the rank-sum test was used for the correlation between the syndrome type and the prognostic grouping, and the Cox proportional risk model was used for multiple factors. Results The median survival of the 72 patients with esophageal cancer was 17.9 months. The univariate analysis of the result showed that the presence of organ metastasis, the presence of lung metastasis, and the post-treatment symptom self-assessment and length of herbal medication were related to the prognosis of advanced esophageal cancer treated with TCM. The rank-sum test between the TCM syndrome elements, and survival prognosis grouping showed that the syndrome element of Qi stagnation may also affect prognosis. The result of the multi-factorial analysis showed that the factor of the duration of the TCM administration was an independent factor that affects the prognosis of advanced esophageal cancer treated with TCM. Conclusion The duration of TCM treatment affected the prognosis of patients with advanced esophageal cancer. [ABSTRACT FROM AUTHOR]