Objective To explore the efficiency and prognostic factors of radiotherapy plus immunotherapy for unresectable locally advanced esophageal squamous cell carcinoma.Methods 63 patients with unresectable locally advanced esophageal squamous cell carcinoma who received radiotherapy combined with immunotherapy from August 2019 to March 2023 were selected,and the treatment effect and prognosis were recorded.The age,sex,ECOG,grade,tumor location,tumor size,AJCC stage,timing of ra-diotherapy,radiotherapy dose,immunotherapy cycle,smoking history,drinking history,baseline NLR,PLR,LMR,FIB,DD,ALB,ALP of the patients were collected to analysis the prognostic factors of radio-therapy and immunotherapy combined with unresectable locally advanced ESCC.Results The ORR of 63 patients was 62%and the DCR was 92%.Univariate analysis showed that age,tumor size,AJCC stage,im-munotherapy cycle,baseline LMR,DD,ALP were related to the efficacy of the unresectable locally advanced ESCC with radiotherapy plus immunotherapy(P<0.05);Sex,ECOG,grade,tumor location,tim-ing of radiotherapy,radiotherapy dose,smoking history,drinking history,baseline NLR,PLR,FIB,ALB were not related to the efficacy of the unresectable locally advanced ESCC with radiotherapy plus immu-notherapy(P>0.05).Multivariate analysis showed that tumor size,immunotherapy cycle,baseline LMR,and baseline DD were independent risk factors affecting the prognosis of unresectable locally advanced ESCC with radiotherapy plus immunotherapy(P﹤0.05).Conclusion Radiotherapy plus immunotherapy is effective in the unresectable locally ad-vanced ESCC.Tumor size>9.4 cm,immunotherapy cycle≤5,baseline LMR>2.7,and baseline DD>106 μg were high-risk factors affecting the prognosis of unresectable locally advanced ESCC with radiotherapy plus immunotherapy.