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Financial toxicity (FT) is increasingly recognized as an important patient-centered burden in cancer care. However, the heterogeneity of FT and its associations with healthcare utilization and catastrophic health expenditure (CHE) among patients with primary liver cancer (PLC) remain insufficiently understood. This study aimed to identify latent profiles of FT among patients with PLC and to examine their associations with healthcare utilization and CHE. We conducted a retrospective cohort study of consecutive adult patients with PLC who received inpatient and/or outpatient care between December 2024 and December 2025 (N = 720). FT was assessed using the COmprehensive Score for FT and multidimensional hardship indicators, including material hardship, financial worry, and coping behaviors. Latent profile analysis was used to identify FT profiles. Healthcare utilization outcomes included annual counts of outpatient visits, inpatient admissions, and emergency department visits. CHE was defined as annual out-of-pocket spending exceeding 40% of household capacity to pay, with a 25% threshold used in sensitivity analyses. Associations between FT profiles and utilization were estimated using covariate-adjusted negative binomial regression, and associations with CHE were estimated using covariate-adjusted logistic regression. A 3-profile solution was identified, comprising low FT (45.0%, n = 324), moderate FT (37.5%, n = 270), and high FT (17.5%, n = 126). Overall, the mean COmprehensive Score for FT score was 25.0 (standard deviation 10.9), and CHE occurred in 27.0% of participants. Compared with the low FT profile, the moderate and high FT profiles were associated with lower outpatient visit rates but higher inpatient admission and emergency department visit rates. CHE prevalence increased stepwise across the low, moderate, and high FT profiles. In adjusted models, moderate FT and high FT were associated with higher odds of CHE compared with low FT. Findings were robust using the 25% capacity-to-pay threshold. Patients with PLC exhibit distinct FT profiles that are strongly associated with healthcare utilization patterns and CHE risk. Routine FT screening and profile-informed interventions may help improve care continuity and strengthen financial protection in PLC management.