Objective To investigate the clinical efficacy and safety of Apatinib in treating the advanced esophageal cancer and their prognosis in elderly patients.Methods Totally 52 elderly patients with advanced esophageal cancer who met the inclusion and exclusion criteria at our hospital from March 2015 to August 2017 were retrospectively enrolled.They were treated with Apatinib.The clinical efficacy,adverse reactions and influencing factors for the prognosis were analyzed.Results The partial remission rate(PRR) was 25.0％ and the disease control rate(DCR)was 71.2％ in 52 patients.The main adverse reactions were hypertension,hand-foot syndrome and proteinuria,with the incidence of 50.0％,38.5％ and 36.5％,respectively.The degree of adverse reactions was mainly grade 1 ～ 2.The median progression-free survival(PFS)was 3.8 months,and the median overall survival(OS)was 7.0 months.Univariate analysis (log-rank test) indicated that the degree of adverse reactions(x2 =5.075,P =0.024) and the Eastern Cooperative Oncology Group (ECOG) score (x2 =7.550,P =0.006)were associated with OS in elderly patients with advanced esophageal cancer.Cox multivariate regression analysis showed that the degree of adverse reactions(HR =1.963,P =0.045)and ECOG score(HR =0.458,P =0.015)were the independent influencing factors for OS in elderly patients with advanced esophageal cancer.Conclusions Due to mild adverse reactions and a high safety,Apatinib still has a certain clinical efficacy in the treatment of elderly patients with advanced esophageal cancer.Moreover,patients with the low ECOG score and high degree of adverse reactions have better prognosis.