OBJECTIVE: The incidence and mortality related to esophageal adenocarcinoma (EAC) has been rising in the United States. Meanwhile, the number of diagnostic and therapeutic procedures has increased in number and improved technologically. However, the impact of these advances on the survival of EAC in clinical practice remains unknown. METHODS: Patients with histologically proven EAC between 1973 and 1997 were identified in registries of the Surveillance, Epidemiology, and End Results database, and analyzed in 5-yr time periods. The observed and relative survival rates were calculated. The joint influence of the time of diagnosis, stage and grade of cancer, demographic features, surgical therapy, and radiotherapy were assessed in Cox proportional hazard survival analyses. RESULTS: Between 1973 and 1997, we identified 4835 patients with EAC. The 1-yr and 5-yr observed survival rates increased from 34% and 5% during 1973-1977 to 44% and 13% during 1993-1997 (p < 0.05). In the Cox survival analysis, the more recent year of diagnosis, early stage of tumor, younger age at presentation, receiving radiotherapy or surgery were independent predictors of reduced risk of mortality. The proportion of patients with in situ EAC and those with local spread increased progressively from 0.3% and 17.7% in 1973-1977 to 2.3% and 25.3%, respectively, in 1993-1997 (p < 0.05). The proportion of patients receiving radiation therapy either before or after surgery has increased from 7% in 1973-1977 to 16% in 1993-1997 (p < 0.05). CONCLUSIONS: The short- and long-term survival of patients with EAC has improved slightly in the United States over the past 25 yr. Some of the improvement may be related to an increase in the number of younger patients, and in cases with in situ and localized cancers. However, the overall survival of patients with EAC remains dismal. © 2003 by Am. Coll. of Gastroenterology.