To investigate the incidence rate of primary liver cancer (PLC) in China in recent decades. Cancer registration data from 1988 to 2005 were used to analyze the incidence trends of PLC in 11 cities and counties in China. We estimated crude, age-specific, and age-standardized incidence rates of PLC. We also analyzed the annual percent change of incidence rate. From 1988 to 2005, a total of 97 462 liver cancer patients, among whom 75% were men, were diagnosed in the covered areas. The crude and age-standardized incidence rates in the combined population were 24.27/100 000 and 18.55/100 000, respectively. The age-standardized incidence rate was 28.15/100 000 for men and 9.31/100 000 for women. A decreasing trend was observed in the age-standardized incidence rate, with an annual percent change of −1.44% (P<0.05). Analysis on the basis of geographic location showed that the incidence rate was higher in rural areas than in urban areas. The crude and age-standardized incidence rates were 35.78/100 000 and 34.34/100 000 for rural areas and 21.64/100 000 and 15.72/100 000 for urban areas, respectively. During the past 18 years, the overall incidence rate of PLC had been decreasing gradually in 11 covered areas in China. Further studies are required to identify the risk factors influencing the incidence trend of liver cancer.