肝细胞癌（HCC）治疗模式正逐步向局部与系统治疗相结合的个体化、序贯化方向发展。TACE联合微波消融（MWA）作为重要的局部联合治疗策略，其疗效受到肿瘤体积与序贯时间窗的双重影响。本文系统综述了TACE-MWA在不同肿瘤体积分层（≤3 cm、3~5 cm、≥5 cm）及不同序贯时间窗（同步/超短、1~4周、长间隔/分步）下的临床证据与机制基础。TACE通过减少肿瘤血供降低“热沉效应”，碘化油沉积则提升MWA的显影与热增效；二者均可诱导免疫原性细胞死亡，激活系统性抗肿瘤免疫。在中等大小（3~5 cm）肝癌中，TACE后1~4周内行MWA可显著提高完全缓解率并延长肿瘤进展时间；对于大/巨大肝癌（≥5 cm），常需采用分步减瘤或联合靶向/免疫治疗的多模态策略。目前证据仍以回顾性研究为主，存在显著的异质性，包括TACE/MWA技术差异、终点定义不统一、患者基线资料不一致等，限制了结论的普适性。基于肿瘤体积-时间窗的个体化序贯治疗策略具有明确的病理生理学基础与临床获益趋势，但在“血流动力学最佳窗口”与“肝功能安全窗口”之间需综合权衡。中性粒细胞与淋巴细胞比值（NLR）、NK细胞动态等外周免疫标志物可能为时间窗优化提供潜在依据，但其因果作用仍需前瞻性验证。未来研究建议应开展多中心、分层随机试验，将“时间窗”作为核心变量，并系统采集血流动力学、免疫及肝功能动态指标；同时需统一技术规范与终点评估标准，以建立基于“肿瘤体积-时间窗-血流动力学/免疫动态”的个体化治疗体系，推动肝癌联合治疗向精准化、循证化方向发展。

The treatment mode of hepatocellular carcinoma (HCC) is gradually evolving towards individualized sequential local combined with systemic therapy. TACE combined with microwave ablation (MWA) is an important local combined therapy for HCC, and its efficacy is affected by both tumor volume and sequential time window. In this article, clinical evidence and mechanism of TACE-MWA in different stratifications of tumor volume (≤3 cm, 3-5 cm, ≥5 cm) and different sequential time windows (synchronous/ultrashort, 1-4 weeks, long interval/sequential). TACE can reduce the ‘heat sink effect’ by reducing the blood supply of tumors, while lipiodol deposition can improve the development and thermal efficiency of MWA. Both of them can induce immunogenic cell death and activate systemic anti-tumor immunity. For medium-sized HCC (3-5 cm), MWA within 1-4 weeks after TACE can significantly improve the complete remission rate and prolong the tumor progression time. For large/huge HCC (≥5 cm), multi-modal strategy of sequential tumor reduction or combined with targeted therapy/immunotherapy. Existing evidence is still mainly based upon retrospective research, with a significant degree of heterogeneity, including differences in TACE/MWA technology, inconsistent definition of endpoint, and different baselines of patients, which limit the universality of the conclusion. Individualized sequential strategy based on tumor volume and time window possesses definite pathophysiological evidence and clinical benefit trend. However, it is necessary to comprehensively weigh between‘the optimal window of hemodynamics’and‘the safe window of liver function’. Peripheral immune markers (such as NLR and NK cell dynamics) may provide potential evidence for time window optimization, whereas the causal effects remain to be verified by prospective study. Subsequently, multi-center stratified randomized trials should be carried out, with‘time window’as the core variable, and dynamic indexes of hemodynamics, immunity and liver function should be systematically collected. In addition, it is necessary to unify technical specifications and endpoint evaluation standards, aiming to establish an individualized treatment system based on‘tumor volume-time window-hemodynamics/immune dynamics’and promote the evolution of combined therapy for HCC in the precise and evidence-based direction.