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
In brief
Non-capital hospitals had 19% to 24% higher mortality in advanced lung cancer
Among 27,482 patients from outside South Korea's capital region who had lung cancer surgery, survival for localized disease was similar whether surgery took place locally or in the capital. For regional and distant disease, adjusted five-year mortality was about 19% and 24% higher, respectively, at non-capital hospitals. The observational study cannot explain the gap, underscoring the need to improve access to advanced cancer care.
- Journal
- Translational lung cancer research (Q1)
- Published
- 23 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Hee Sung Kim, Kyoung Eun Yeob, So Young Kim, Hye Sook Han, Jong Hyock Park
- PMID
- 42870884
- DOI
- 10.21037/tlcr-2026-0533
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 18 October 2026): Regional disparities in lung cancer surgery and survival
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 vs. lowest quintile, adjusted odds ratio (aOR) 4.357; 95% confidence interval (CI), 3.560-5.333] and was higher among urban residents (aOR 2.124; 95% CI, 1.948-2.316) and medical insurance holders versus Medical Aid recipients (aOR 3.064; 95% CI, 2.522-3.772). Survival did not differ by hospital region for localized-stage disease, whereas non-capital hospitals showed higher mortality for regional (3-year aHR 1.219; 95% CI, 1.076-1.382; 5-year aHR 1.188; 95% CI, 1.067-1.322) and distant stages (5-year aHR 1.239; 95% CI, 1.011-1.519). 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.