Objective To explore the controlling nutritional status CONUT and systemic immune - inflammatory index SII neutrophil-lymphocyte ratio NLR and platelet-lymphocyte ratio ratio PLR in predicting the efficacy of immunotherapy in patients with locally advanced or metastatic esophageal squamous cell carcinoma and the predictive efficacy of combining the above four indicators. Method Patients with esophageal squamous cell carcinoma treated with immune combined chemotherapy or chemoradiotherapy in Cancer Hospital of Shandong First Medical University and Gaomi People 's Hospital from January 2018 to December 2021 were retrospectively analyzed. The hematological examination results of the patients within 1 week before treatment were collected and the CONUT score SII NLR and PLR values of the patients were calculated. The dependent receiver operating characteristic curve ROC curve was drawn based on one-year overall survival and the best cut-off values of CONUT SII NLR and PLR were calculated. The primary end point was overall survival OS and the secondary end points were progression-free survival PFS and objective response rate ORR . Result A total of 335 patients were enrolled. According to the ROC curve the cut-off values of CONUT SII NLR and PLR were 2. 5 749. 69 2. 795 and 202. 975 respectively. The median OS was 27. 3 22. 9-31. 7 months in the low COUNT group and 23. 3 16. 29-30. 25 months in the high COUNT group P < 0. 001 . The median PFS was 10. 9 9. 96-11. 84 months in the low count group and 7. 6 6. 51-8. 63 months in the high count group P = 0. 001 . The median OS of the low SII group and the high SII group were 27. 9 25. 12 - 30. 68 months and 17. 9 16. 99 - 18. 81 months P < 0. 001 respectively. The median PFS of the low SII group and the high SII group were 11. 6 10. 69-12. 51 months and 7. 5 (6. 56-8. 44) months P < 0. 001 respectively. The median OS of the low NLR group and the high NLR group were 28. 37 25. 25-31. 49 months and 18. 6 16. 20-21. 0 months respectively P = 0. 016 . The PFS was 10. 93 9. 96-11. 90 months and 7. 53 6. 80-8. 26 months respectively P < 0. 001 . The median OS of the low PLR group and the high PLR group were 27. 5 23. 7-31. 3 and 21. 0 14. 3-27. 7 months respectively P = 0. 007 and the median PFS were 10. 9 9. 9 - 11. 9 and 8. 3 7. 5 - 9. 2 months respectively P < 0. 001 . The combined prediction efficiency of the four indicators was higher than that of the single CONUT score. Conclusion For patients with locally advanced or metastatic esophageal squamous cell carcinoma treated with immunotherapy patients with low CONUT score before treatment have better OS and PFS than those with high CONUT score and the predictive value of combined inflammation indicators is better.