Aristolochic acids (AAs) is a group of nitrophenanthrene compounds comprised of AAⅠ, AAⅡ, AAⅢ and AAⅣ, which are widely distributed in Aristolochiaceae plants. Long-term use of drugs containing AAs could lead to aristolochic acid nephropathy (AAN) and urinary tract tumors. Active metabolites of AAs could form AA-DNA adducts with DNA, which subsequently induce characteristic A-T transversion mutation known as AA mutational signature. In 2017, Sci Transl Med reported that AAs and their derivatives were widely implicated in liver cancers in Taiwan, China and throughout Asia, suggesting that additional measure should be taken for primary prevention through avoidance of AAs exposure. This report has triggered a series of worldwide discussion on whether AAs could cause liver cancer. We analyze this research focus in the present paper and mainly discuss the controversial points of the liver carcinogenicity related to AAs in the literature, so as to provide scientific and objective evidence to evaluate the association of AAs exposure with liver cancer development in Chinese population; meanwhile, the questions that need to be solved for the safety use of AAs are also presented, and some thoughts on them were put forward.