Abstract: Objective: To describe the spatiotemporal distribution patterns of incidence and mortality of primary liver cancer(PLC) in China and provide epidemiological evidence for the prevention and control of this malignancy. Methods: Based on data from the China Cancer Registry Annual Report from 2004 to 2019, the Joinpoint regression model was used to calculate the annual percentage change(APC). The spatial autocorrelation analysis was conducted to reveal the spatial distribution patterns. A Bayesian spatial model was applied to estimate the relative risk(RR) for each province. Results: The age-standardized incidence rate(ASIR) of PLC in China remained generally stable between 2004 and 2019. It showed a downward trend after 2011(APC=-2.09%), and the age-standardized mortality rate(ASMR) also showed a downward trend after 2011(APC=-2.31%). The CentralSouth region and Fujian Province were identified as high-incidence areas, with Guangxi(RR=1.80), Hainan(RR=1.67), and Fujian(RR=1.42) showing the highest risks. The urban-rural gap in PLC incidence and mortality narrowed, with the rural-to-urban ratio of PLC incidence decreasing from 1.8 to 1.1. Both PLC incidence and mortality rates exhibited significant positive spatial autocorrelation(P<0.05). Conclusion: The spatial distribution of PLC incidence and mortality in China exhibits a high-incidence clustering pattern centered on the Central-South region and extending to Fujian, with the urban-rural gap tending to narrow. The age-standardized incidence and mortality rates of PLC in the Central-South region are similar, suggesting that early prevention of PLC should be prioritized in this region.