To systematically review the prevalence of depressive symptoms in patients with primary liver cancer (PLC) worldwide. Methods: PubMed, Embase, The Cochrane Library, Web of Science, China Biomedical Literature Database, CNKI, Wanfang database and VIP database were systematically searched to identify literature investigating the prevalence of depressive symptoms in PLC patients from the inception of these databases until April 2022. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included literature. Meta-analysis was performed using Stata 16.0 software. Results: A total of 20 literatures were included. Meta-analysis results showed that the prevalence of depressive symptoms in PLC patients was 47.1% (95%CI 38.7%～55.5% ). The results of subgroup analysis showed that higher rates of depression were observed in patients with the following characteristics: Chinese, < 60 years old, low income, unemployment, stage Ⅳ tumor, no treatment and assessment using the HADS screening tool. Conclusion: PLC patients had a high prevalence of depressive symptoms.