This study aims to investigate the specimen size effect of compressive strength in 3D printed concrete containing coarse aggregate (3DPCA). Firstly, we compare the specimen size effect of compressive strength in mold-cast concrete (CC) and 3DPCA. Through X-CT scans and image analysis, the underlying mechanisms of this specimen size effect in 3DPCA are revealed. The results indicate that 3DPCA exhibits a less pronounced specimen size effect on compressive strength when loaded along the Z direction compared to CC, due to the presence of interlayer weak zones that mitigate the influence of size variations. Specifically, when the water-binder ratio varies between 0.3 and 0.5, the size coefficient of printed sample is reduced by 0.01–0.07 compared to cast sample. Similarly, variations in coarse aggregate content result in a size coefficient for printed sample that is 0.01–0.05 lower than cast sample. Higher porosity increases the specimen size effect of 3DPCA, but good printing quality can mitigate this influence. A modified Weibull model integrating water-binder ratio and coarse aggregate content was proposed, providing precise predictions of the specimen size effect on 3DPCA's compressive strength, with a correlation coefficient exceeding 93 %.