Objective <p>To explore the clinical significance of albumin(Alb) to the derive(d) neutrophil-to-lymphocyte ratio(NLR) in patients with esophageal squamous cell carcinoma (ESCC) aged 60 years and above.</p> Methods <p>328 patients with ESCC at Shanxi Province Cancer Hospital were enrolled in this study. The dNLR was calculated using the following formula: neutrophil count / (leukocyte count − neutrophil count). Alb to dNLR or the Alb/dNLR ratio was calculated by dividing the Alb level by the dNLR level.Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff values for Alb to dNLR.</p> Results <p>ROC analysis displayed that the cut-off value of Alb to dNLR was defined to be 20.28 U/mL. The AlbtodNLR was not related to clinical features but to survival status (all <i>P</i> &gt; 0.05). ESCC patients aged 60 years and above with a high AlbtodNLR had better survival than those with a low Alb-to-dNLR (<i>P</i> = 0.005). Similar results were observed in male patients with ESCC (<i>P</i> = 0.001), subgroups with upper and middle locations (<i>P</i> = 0.013 and 0.017), tobacco consumption (<i>P</i> = 0.004), non-drinkers (<i>P</i> = 0.029), well and moderate differentiation (<i>P</i> = 0.014), lymph node involvement (<i>P</i> &lt; 0.001), advanced T stage (<i>P</i> = 0.014), and advanced TNM staging (<i>P</i> = 0.001). Univariate Cox regression analysis indicated that tumor grade, T staging, lymph node metastasis(LNM), TNM staging, and Alb to dNLR ratio were predictors of death from ESCC. In a multivariate Cox regression analysis, a lower AlbtodNLR levels, and advanced T stage were associated with an increased risk of ESCC-related death.</p> Conclusions <p>Collectively, Alb to dNLR were inversely associated with outcome and were regarded as an independent influencing factor for ESCC subpopulation aged 60 years and above.</p>