SMYD3 (SET and MYND domain-containing protein 3) is involved in histone modification, which initiates oncogenesis by activating transcription of multiple downstream genes. To investigate associations of variable numbers of tandem repeats (VNTR) variants in the SMYD3 gene promoter, SMYD3 serum levels and SMYD3 mRNA expression in hepatitis B virus (HBV) infection and clinical progression of related liver disease. SMYD3VNTRs were genotyped in 756 HBV patients and 297 healthy controls. SMYD3 serum levels were measured in 293 patients and SMYD3 mRNA expression was quantified in 48 pairs of hepatocellular tumor and adjacent non-tumor liver tissues. Genotype SYMD3 VNTR 3/3 was more frequent among HCC patients than in controls (P adjusted = 0.037). SMYD3 serum levels increased according to clinical progression of liver diseases (P = 0.01); HCC patients had higher levels than non-HCC patients (P = 0.04). Among patients with SMYD3 VNTR 3/3, HCC patients had higher SMYD3 levels than others (P < 0.05). SMYD3 mRNA expression was up-regulated in HCC tumor tissues compared to other tissues (P = 0.008). In conclusion, upregulation of SMYD3 correlates with the occurrence of HCC and SMYD3 VNTR 3/3 appears to increase the risk of HCC through increasing SMYD3 levels. SMYD3 may be an indicator for HCC development in HBV patients.Although effective hepatitis B virus (HBV) vaccines are in use worldwide, HBV-related liver diseases are still a major health concern with approximately 257 million chronic infections and 887,000 deaths in 2015 1 . HBV is the main cause of primary hepatocellular carcinoma (HCC) 2 . The risk of HCC development is approximately 40 times higher in chronic HBV carriers (CHB) than in non-carriers 3 . Vietnam has a high prevalence of HBV infections, ranging from 10-20% in the general population and 20-40% among high-risk groups 2,4 . As a result, Vietnam is one of the countries with a high incidence of HCC with >25,000 new cases reported in 2018 5,6 .Further to viral factors contributing to cancer development, methylation of histone proteins is an important mechanism involved in multiple types of cancers including HCC 7,8 . Methylation of histone proteins at lysine residues can lead to chromatin remodelling, transcription, and signal transduction 9 . The SET and MYND domain containing proteins (SMYDs) belong to a family of the multi-domain SET-containing histone lysine methyltransferases and play a crucial role in histone methylation. To date, five SMYD family members have been recognized (SMYD1-SMYD5). SMYD3 is the most important member, as several findings have demonstrated its role in tumor cell growth and its increased expression in various cancers.SYMD3 promotes dimethylation and trimethylation of histone H3 lysine 4 (H3K4), which initiates oncogenesis by activating transcription of multiple downstream target genes 10,11 . SYMD3 overexpression causes cell proliferation, migration and adhesion, whereas suppression by RNAi inhibits cell proliferation and migration, indicating that SMYD3 plays an important role i...