As a globally prevalent malignancy with poor prognosis, liver cancer exhibits a well-established pathological association with the gut microbiota (GM). In recent years, increasing attention has been paid to the role of the GM in the initiation and pathological progression of liver cancer, which often evolves through stages of hepatitis, liver fibrosis, cirrhosis, and ultimately liver cancer. The GM influences the development of liver cancer through multiple mechanisms, including the regulation of the hepatic immune microenvironment by the GM and its metabolites, the mediation of epigenetic modifications and exosomal signaling pathways, and the synergy with other risk factors. Notably, patients with liver cancer commonly demonstrate reduced GM diversity and enriched pathogenic bacteria. These findings offer a new theoretical foundation and suggest potential therapeutic strategies such as probiotic supplementation, rational antibiotic use, fecal microbiota transplantation, combination therapies integrating GM modulation with conventional treatments, and integrated treatment regimens based on the above methods. This article reviews the pathogenesis of liver cancer mediated by GM dysbiosis and the research advances in GM-targeted interventions in recent years, providing reference for future studies on the pathogenesis and treatment of liver cancer.