Objective To investigate the nagative emotions, self-care ability and quality of life (QOL) in elderly patients with primary hepatic carcinoma (PHC) undergoing transcatheter arterial chemoembolization (TACE), and to analyze the influencing factors for QOL. Methods A total of 348 elderly PHC patients who received TACE treatment in our hospital from March 2020 to March 2023 were recruited in the study. Self-rating anxiety scale (SAS), self-rating depression scale (SDS), exercise of self-care agency scale (ESCA) and European Organization for Research of Cancer (EORTC) quality of life-core 30 questionnaire (QOL-C30) were used to investigate the negative emotions, self-care ability and QOL in this patients before surgery and at three months after discharge. SPSS statistics 22.0 was used for data analysis. According to the data type, t test or one-way analysis of variance was performed for comparison between groups. Multivariate linear regression model was employed to analyze the related factors affecting the postoperative QOL in them, and the effect of the obtained risk factors on anxiety, depression and self-care ability was analyzed. Pearson correlation analysis was conducted to analyze the correlation of postoperative QOL with anxiety, depression and self-care ability in these elderly patients. Results After TACE, the SAS and SDS scores were significantly decreased, while those of ESCA and QOL-C30 were obviously increased in elderly PHC patients (P<0.05). There were statistically differences in postoperative anxiety, depression and self-care ability among the patients with different ages, history of hepatocellular carcinoma resection, and informed condition of disease (P<0.05). Multivariate linear regression analysis showed that age (β=-0.320; P<0.001), history of hepatocellular carcinoma resection (β=-0.245; P=0.001) and informed condition of disease (β=-0.290; P=0.001) significantly affected the QOL in these patients after TACE, and jointly explained 69.30% of the variation in their QOL after TACE (F=35.128, P<0.001). Pearson correlation analysis showed that the score of postoperative QOL-C30 was negatively correlated with the SAS and SDS scores (r=-0.627, -0.609; P<0.05), and positively with the ECSA score (r=0.383; P<0.05) in elderly PHC patients. Conclusion After TACE treatment, though the QOL level is increased in the elderly PHC patients, the overall level is still poor. For the elderly PHC patients who are≥75 years old, have a history of hepatocellular carcinoma resection and ignorance of disease condition, they have worse QOL, and are prone to anxiety and depression and worse self-care ability. It is suggested that attention should be paid to the postoperative QOL in elderly patients with above characteristics in clinical practice, and guidance of negative emotions and cultivation of self-care ability attention should also be focused on.