Abstract: Objective: We explored clinicopathological characteristics, immune-, and survival-influencing factors in patients who experienced ultra-long-term survival (≥10 years) of advanced (stage Ⅱ+Ⅲ+Ⅳ) esophageal squamous cell carcinoma. Methods: The optimal neutrophil-to-lymphocyte ratio (NLR) cutoff value was determined using the X-tile software, and statistical analyses were performed with SPSS 27.0. Comparisons between groups were performed using the Pearson's chi-square test. Survival curves of patients with different clinical characteristics were plotted using the Kaplan-Meier method (Log-rank test). The enter method in the Cox regression analysis model was employed to identify independent prognostic risk factors for ultra-long-term survivor patients, and a figure was subsequently generated using GraphPad Prism 10.1.2. Results: Patient characteristics that contributed to significantly (P<0.001) elevated rate of ultra-long-term survival included female sex, aged <60 years, residence in a high-incidence area, rural residence, non-smoker, non-drinker, positive family history, BMI <18.5, mid-thoracic tumor, negative for lymph node metastasis, and TNM stage Ⅱ. A significantly elevated proportion of ultra-long-term survivors was also observed in the low NLR group (P=0.008). Among the ultra-long-term survivor patients, those who were female, aged <60 years, from high-incidence areas, urban residents, non-smokers, with a positive family history, mid-thoracic tumors and negative lymph node metastasis exhibited the best survival outcomes. By TNM stage, stage Ⅱ patients survived the longest, followed by stage Ⅲ, with stage Ⅳ survival being the shortest. Conclusions: Male, age ≥60 years, rural residence, primary tumor longest diameter ≥4 cm, lymph-node positive, TNM stage Ⅲ or Ⅳ were all independent risk factors against ultra-long-term patient survival.