ArticleTranslational lung cancer research2026
Regional disparities in lung cancer surgery and survival in South Korea: a nationwide population-based retrospective cohort study using linked cancer registry and national health insurance data.
Article in Translational lung cancer research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Lung cancer incidence is rising in South Korea, where cancer care is increasingly concentrated in capital-region hospitals. Whether this centralization improves surgical outcomes for patients residing outside the capital region-or mainly imposes travel and access burdens without a universal survival benefit-remains unresolved. We examined regional patterns of surgical hospital utilization and stage-specific survival among non-capital residents undergoing lung cancer surgery. Methods: In this nationwide population-based retrospective cohort study, we linked the Korea Central Cancer Registry and the Korean National Health Insurance Service databases to identify adults newly diagnosed with lung cancer (2012-2019). Among 52,521 patients who underwent lung cancer surgery, 27,482 resided in non-capital regions, of whom 13,893 (50.6%) underwent index surgery at capital-region hospitals and 13,589 (49.4%) at non-capital hospitals. Multivariable logistic regression (2017-2019) identified factors associated with capital-region surgery, and Cox proportional hazards models estimated adjusted hazard ratios (aHRs) for 1-, 3-, and 5-year all-cause mortality by stage, hospital type, and histology. Follow-up extended from diagnosis to death or December 31, 2022. Results: Among non-capital residents, surgery at capital-region hospitals was more frequent among women, younger patients, higher-income groups, and those with fewer comorbidities. The likelihood of capital-region surgery increased with income [highest Conclusions: The survival advantage of capital-region hospitals was not universal but confined to advanced-stage disease, likely reflecting unequal access to systemic therapy, clinical trials, and multidisciplinary care rather than differences in surgical quality. Early-stage lung cancer can be safely managed in regional hospitals with adequate surgical capacity. A stage-specific delivery strategy-strengthening regional early-stage surgery while improving non-capital access to advanced treatment-is needed to ensure equitable cancer care nationwide.
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