Primary liver cancer (PLC) remains a global health challenge. Understanding trends in the disease burden and survival is crucial to inform decisions regarding screening, prevention, and treatment. Population-based cohort study using UK primary care data from the Clinical Practice Research Datalink (CPRD) GOLD (2000-2021), replicated in CPRD Aurum. Crude and age-standardized incidence rates (IRs), crude period prevalence (PP), and survival at 1, 5, and 10 years were calculated, and stratified by age, sex, and diagnosis year. The crude IR of PLC was 4.56 (95% CI 4.42-4.70) per 100 000 person-years between 2000 and 2021, with an increase over time across age and sex strata. Sex-specific IR for males was higher than females, 6.60 (95% CI 6.36-6.85) vs. 2.58 (95% CI 2.44-2.74) per 100 000 person-years. Age-standardized IR showed identical trends. Crude PP showed a seven-fold increase over the study period, with PP 0.02% (95% CI 0.019%-0.022%) in 2021, and a 2.8-fold higher PP in males. Survival at 1, 5, and 10 years after diagnosis was 41.7%, 13.2%, and 7.1%, respectively, for both sexes. One-year survival increased only in men, from 33.2% in 2005-2009 to 49.3% in 2015-2019. Over the past two decades, there has been a substantial increase in the number of patients diagnosed with PLC. Despite a slight improvement in median and one-year survival in men, prognosis remains poor. To improve the survival of PLC patients, it is necessary to understand the epidemiological changes and address preventable risk factors associated with liver disease and promote early detection and access to care.