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The Pearl River is one of China’s large rivers, the second-largest river and the fourth-longest river in China. Its unique geography, landform, and climate conditions create unique fluvial geomorphological processes. Affected by human activities and climate change, the fluvial geomorphological processes in the Pearl River Basin have undergone significant changes in recent decades, seriously affecting the river’s sustainable development. This paper critically reviews changes in fluvial geomorphological processes and analyzes influencing factors in the Pearl River Basin with a focus on possibilities for policy overhaul and strategic adjustments.