Objectives: To investigate the association between statin use and the risk of incident cancer and patient survival in patients undergoing maintenance hemodialysis (HD). Methods: We conducted a nationwide retrospective cohort study using data from the Health Insurance Review and Assessment Service in South Korea. Adult patients receiving maintenance HD for at least 3 months were included. Statin exposure was classified as non-users or users based on prescriptions during a 6-month assessment period. Propensity score matching was performed to minimize baseline differences. Outcomes included incident cancer and patient survival. Kaplan–Meier and multivariable Cox regression analyses were used to assess associations. Subgroup analyses were performed by age, sex, and comorbidity burden. Results: Among 60,983 patients included, 25,374 were statin users. In the overall and propensity score-matched cohorts, statin use was not associated with a significant difference in overall cancer incidence. Statin users demonstrated a trend toward improved survival, particularly among elderly patients or those with higher comorbidity scores, although statistical significance varied across analyses. Analysis by statin type, solubility, or intensity did not reveal consistent effects on cancer risk. Among specific cancers, statin use was associated with a lower incidence of liver cancer. Conclusion: Statin use was not associated with overall cancer risk in maintenance HD patients but was linked to reduced liver cancer incidence. Further prospective studies are warranted to clarify the relationship between statin therapy, cancer development, and survival in this population.