Background: To evaluate overall survival (OS), prognostic factors for survival, and treatment outcomes in patients with Stage III/IV endometrial cancer (EC) undergoing neoadjuvant chemotherapy +/- surgery compared to surgery followed by adjuvant chemotherapy. Methods: The National Cancer Database (NCDB) was queried to identify patients with Stage III/IV EC who were treated with chemotherapy. Univariable and multivariable Cox proportional hazards analyses were used to determine independent prognostic factors for OS. Survival was measured from date of diagnosis to the date of last contact or death. Results: From 2004-2012, 31,726 women with stage III/IV EC were identified. . Treatment groups consisted of: 3424 (10.8%) chemotherapy alone (C), 26926 (84.9%) surgery followed by chemotherapy (S+C), and 1412 (4.4%) neoadjuvant chemotherapy followed by surgery (NACT+S). The median age at diagnosis was 64 years (19-90), and 65.8% (n = 35402) of patients had Stage III disease. Reasons for no surgery were: not part of primary treatment plan (77.7%; n = 5859), contraindicated due to patient factors (11.3%, n = 850) or patient refusal (3.6%; n = 268). The majority of patients (86.8%) received multiple chemotherapy agents and 1988 (6.3%) received single agent chemotherapy. Charlson-Deyo score was 0 for 75.3% (n = 2578) of C, 76.7% (n = 20652) of S+C and 77.8% (n = 1098) of NACT+S patients (p < 0.001). Compared to patients who received C alone, S+C and NACT+S were associated with improved median OS (10.9 months vs. 63.3 (HR 0.27 CI 0.26-0.28, p < 0.001) and 24.6 months (HR 0.50, 95% CI 0.47-0.54, p < 0.001), respectively). On multivariate analysis advanced age (HR 1.03, p < 0.001), stage IV disease (HR 2.70, p < 0.001), Charlson Deyo Score (1 – HR 1.13, p < 0.001; 2 – HR 1.32, p < 0.001), and African American race (HR 1.53, p < 0.001) were associated with worse OS.Private insurance (HR 0.87, p < 0.001), income > $63,000 (HR 0.86, p < 0.001) and treatment with S+C (HR = 0.32, p < 0.001) or NACT+S (HR 0.44, p < 0.001) versus C alone were predictive of improved OS. Conclusions: In this analysis of the NCDB, receipt of chemotherapy alone is associated with markedly worse OS than S+C or NACT +S in stage III/IV patients. . Socioeconomic factors including African American race, insurance status and income are independent predictors for survival in this cohort. Where feasible, surgery should be should be incorporated into treatment planning for women with Stage III/IV EC.