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Purpose: Breast cancer in young women is associated with poor prognosis. We aimed to define the role of gene expression signatures in predicting prognosis in young women and to understand biological differences according to age.

Experimental Design: Patients were assigned to molecular subtypes [estrogen receptor (ER)⁺/HER2⁻; HER2⁺, ER⁻/HER2⁻)] using a three-gene classifier. We evaluated whether previously published proliferation, stroma, and immune-related gene signatures added prognostic information to Adjuvant! online and tested their interaction with age in a Cox model for relapse-free survival (RFS). Furthermore, we evaluated the association between candidate age-related genes or gene sets with age in an adjusted linear regression model.

Results: A total of 3,522 patients (20 data sets) were eligible. Patients aged 40 years or less had a higher proportion of …