OBJECTIVE To make clear the relationship between gallstones and gallbladder cancer, the relationship between the size of gallstones and gallbladder cancer, the course of gallbladder cancer, and the relationship among adenoma and carcinoma of gallbladder and ascariasis in the biliary tract. METHODS A total of 3,922 cases of gallbladder cancer from 28 provinces in china from 1986 to 1998 were reviewed, according to a standard protocol called "the clinical epidemiological list of gallbladder cancer". RESULTS Gallbladder cancer accounted for 0.4% - 3.8% of bile tract disease in the same period, averaging 1.53%. Gallbladder cancer accounted for 0.1% - 1.1% of abdominal surgery in the same period. Gallstones were found in 46.7% of the cases of gallbladder cancer, the related risk (RR) of gallbladder cancer with gallstones was 13.7. The average course with gallstones was 10 - 15 years. The gallstone in gallbladder was 3 cm or above in diameter. The ratio of the progression from adenoma to carcinoma of gallbladder was 1.5%. Only 4 cases of ascariasis was reported. CONCLUSIONS Gallbladder cancer and gallstones are closely associated. Patients with gallstone of 3 cm or above in diameter and a course of 10 - 15 years are usually at an increased risk for cancer. We found the adenoma and carcinoma of gallbladder are closely related, and there is no relationship between gallbladder cancer and ascariasis in our group.