Objective To investigate the correlations between neutrophil - to - lymphocyte ratio NLR as well as albumin - to - globulin ratio AGR and overall survival OS of esophageal squamous cell carcinoma ESCC patients and evaluate the prognostic value of their combination. Method A total of 144 ESCC patients who were initially diagnosed and treated with surgical resection in our institution from January 2015 to December 2019 were included in this study and their data of laboratory test and postoperative followup were retrospectively collected and analyzed. The best thresholds of NLR and AGR were determined by receiver operation characteristics ROC curve and the area under curve AUC value was used to evaluate their predictive performance. The prognostic values of NLR and AGR for ESCC patients were evaluated using Kaplan-Meier method and the multivariate Cox regression analysis. Result According to the ROC curves the optimal cut-off values of NLR and AGR for survival prediction of ESCC patients were 1. 45 and 1. 48 respectively. The AUC values of NLR and AGR were 0. 713 95% CI = 0. 628 - 0. 797 and 0. 673 95% CI = 0. 584 - 0. 761 respectively. Kaplan-Meier curves indicated that the median OS of patients with high NLR >1. 45 and low NLR ≤1. 45 was 51. 8 months 95%CI = 36. 2-67. 3 and 20. 1 months 95%CI = 14. 1-26. 2 with a significantly statistical difference χ 2 = 20. 474 P<0. 001 . In contrast preoperative low AGR <1. 48 was significantly associated with poor OS of ESCC patients median ·456· 肿瘤代谢与营养电子杂志 2022 年 8 月 9 日第 9 卷第 4 期 Electron J Metab Nutr Cancer, Aug. 9, 2022, Vol. 9, No. 4 OS 22. 5 months 95%CI = 15. 1 - 29. 9 vs 43. 3 months 95% CI = 25. 7 - 60. 8 χ 2 = 6. 749 P = 0. 009 . The univariate and multivariate Cox analysis identified lymph node metastasis HR = 3. 626 95% CI = 2. 152- 6. 110 P< 0. 001 NLR HR = 1. 960 95%CI = 1. 198-3. 207 P= 0. 007 and AGR HR= 1. 791 95%CI = 1. 099-2. 920 P= 0. 019 as independent prognostic factors for ESCC patients. Additionally we found that the prognosis of ESCC patients could be further stratified by the combination of NLR and AGR 0 point NLR≤1. 45 and AGR≥1. 48 1 point NLR>1. 45 or AGR<1. 48 2 point NLR > 1. 45 and AGR<1. 48 . The higher score the poorer OS in ESCC patients. The median OS of patients with 0 1 and 2 points were 56. 6 months 95%CI = 40. 2- 67. 3 29. 9 months 95%CI = 20. 1-39. 8 and 18. 2 months 95%CI = 12. 1-24. 3 respectively. There were significant survival differences between different patient groups 0 vs 1 point χ 2 = 6. 795 P= 0. 009 0 vs 2 points χ 2 = 19. 529 P<0. 001 1 vs 2 points χ 2 = 7. 011 P = 0. 008 . Conclusion NLR and AGR were identified as sensitive predictors of prognostic assessment and their combination could provide a proper prognostic stratification for ESCC patients.