近年来，肝细胞癌（HCC）发病率持续上升，是全球癌症相关死亡的主要原因之一。尽管手术是唯一可能实现根治的手段，但多数患者初诊时已为中晚期，错失手术机会。随着免疫检查点抑制剂（ICIs）的广泛应用，HCC系统治疗格局发生深刻变革，以ICIs为核心的联合治疗策略显著改善了晚期患者的生存预后。本文系统梳理了免疫治疗在中晚期HCC中的应用新策略，重点围绕三大方向展开：一是晚期系统治疗从“联合增效”到“耐药突破”的立体化探索，涵盖TACE联合靶免方案拓展适应证、立体定向放射治疗（SBRT）逆转免疫耐药及ICIs再挑战策略；二是转化治疗与围手术期管理从“被动切除”到“精准预测”的范式升级，强调基于术后AFP分层指导辅助治疗决策及高危人群强化干预；三是精准预测从影像形态到免疫微环境的决策升级，影像组学、液体活检及多组学整合为个体化治疗提供了可及性高、动态监测能力强的预测工具。上述进展共同推动中晚期HCC治疗向精准化治疗方向发展，为实现“降期-转化-根治-维持”的全链条管理提供了新思路。

In recent years, the incidence of hepatocellular carcinoma (HCC) has been persistently increasing , becoming one of the leading causes of cancer-related deaths worldwide. Although surgery is the only potential option for radical cure, most patients are diagnosed in the middle and advanced stage upon admission and miss the opportunity of surgery. With widespread application of immune checkpoint inhibitors (ICIs), systemic treatment modality for HCC has undergone profound changes. Combined treatment with ICIs as the core has significantly improved the survival and prognosis of advanced HCC patients. In this article, novel application strategies of immunotherapy in advanced HCC were systematically illustrated in three major directions. Firstly, stereotactic exploration of systemic therapy from "combined treatment for higher efficacy" to "drug resistance breakthrough", including TACE combined with targeted immunotherapy for extending indications, stereotactic body radiotherapy (SBRT) for reversing immune resistance and ICIs re-challenge strategies. Secondly, the paradigms of translational therapy and perioperative management have been evolved from "passive resection" to "precise prediction", emphasizing utilizing stratified guidance of postoperative AFP to assist treatment decision-making and intensified interventions for high-risk populations. Thirdly, precise prediction has been updated from image morphology to immune microenvironment. Radiomics, liquid biopsy and multi-omics integration provide prediction tools with high accessibility and strong dynamic monitoring capability for individualized treatment. These progresses jointly promote the development of advanced HCC treatment to precise treatment, offering novel ideas for realizing the full-course management of "downstaging-translation-radical treatment-maintenance".