Abstract: Objective To research the level of the serum homocysteine(Hcy) in patients with primary hepatic carcinom(PHC), and to explore the correlation with clinical stage and Child-Pugh grade of liver function. Methods Total 115 patients of PHC who diagnosed in our hospital from June 2018 to December 2019 were collected as PHC group, and 69 cases of normal physical examination in the same period were collected as control group. The differences of serum Hcy, biochemical indexes(liver and kidney function, blood lipid, blood glucose) and tumor markers were compared. The correlation between serum Hcy and clinical stage and Child-Pugh grade of liver function was analyzed. Results The level of the serum Hcy in the PHC group [13.56(10.68, 17.96) μmol/L] was significantly higher than that in the control group [10.20(7.70, 11.89) μmol/L], and the difference was statistically significant(P<0.05). The serum Hcy level in PHC group was significantly different between different clinical stages and different liver function(all P<0.05). There was a positive correlation between the serum Hcy and the stage and Child-Pugh grade of liver function(r=0.585, P<0.05; r=0.625, P<0.05). After adjusting other risk factors of PHC, the serum Hcy level was an independent risk factor for PHC(OR=1.409, P=0.003). Conclusion The higher the serum Hcy level in PHC patients, the later the clinical stage and the more serious the liver function grade. Hcy can be used as a monitoring index with PHC, and has certain clinical significance for disease evaluation and prognosis prediction.