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Clinical utility of a simple primary culture method in hepatocellular carcinoma patients. BACKGROUND AND AIM: The clinical utility of our designed primary culture method in patients with hepatocellular carcinoma was investigated. METHODS: Specimens obtained from ultrasound-guided fine-needle aspiration of 108 hepatocellular carcinoma patients were cultured. The associations of the cellular proliferative speeds with cancer invasiveness and 1-year survivals were analyzed. RESULTS: Successful cultures were achieved in 105 patients (97.2%). Ten hepatocellular carcinoma and nine cancer-associated fibroblast cell lines were established. The cells obtained from patients with American Joint Committee on Cancer TNM staging ≥ IIIB upon entering the study had higher proportion of rapidly proliferative cancer cells than those from patients with staging ≤ IIIA (P < 0.005). For Barcelona Clinic Liver Cancer classification A or B patients receiving palliative transcatheter chemoembolization, patients with rapidly proliferative cancer-associated fibroblasts showed higher incidence of cancer-related death than patients with other proliferative patterns (P = 0.0385). The influence of the presence of rapidly proliferative cancer cells on survivals in this group could not be calculated due to a very small number of this kind of patients (9.5%). For Barcelona Clinic Liver Cancer classification C patients receiving non-curative treatment, the incidence of rapidly proliferative cancer cells was 45.2%. Patients with rapidly proliferative cancer cells showed higher incidence of cancer-related death than patients with other proliferative patterns in patients receiving chemoembolization (P = 0.0452) and in patients receiving conservative treatment (P = 0.0206). CONCLUSION: Our method can provide cells from individual patient for researches and predict outcomes in patients receiving non-curative treatment of hepatocellular carcinoma.