Editorial

EASL Recognition Award Recipient 2016: Prof. Jordi Bruix
Peter R. Galle
University Medicine, Department of Internal Medicine, Langenbeckstrasse 1, Mainz, Germany

Recognition of an individual with a prestigious award such as the
‘‘EASL Recognition Award 2016” typically comes as a result of the
cumulative development of a scientific career paralleled by a
longstanding history of many different contributions. In most
cases the minimum requirement to fully appreciate their contribution is an extensive list of achievements. Not so in the case of
Prof. Jordi Bruix: Four letters are enough, to comprehensively
summarize his role in the field of hepatocellular carcinoma
(HCC) and they are recognized instantly amongst hepatologists
all over the world: BCLC.
When Jordi Bruix (Fig. 1), todays Director of the Barcelona
Clinic Liver Cancer (BCLC) group, founded BCLC almost 30 years
ago, together with Dr. Brú (Fig. 2), a radiologist with major expertise in diagnostic and interventional ultrasonography, he was
thinking big. At that time not many clinicians and scientists were
interested in HCC, guidelines were non-existing and treatment
options limited. Over the years the BCLC group continuously
contributed to diagnosis and treatment of HCC, evaluated the
available evidence and – most importantly – crafted the BCLC
staging system (Fig. 3). This staging system today sets the standard of care in clinical practice, is integrated in most guidelines
and is regularly used in clinical trials.
After almost three decades of BCLC, his continuous contributions have positioned him as one of the most influential researchers in the world in the field of clinical medicine as recognized by
Thomson Reuters’ listing in ‘‘The World’s Most Influential
Scientific Minds 2014 and 2015”.
Jordi was born in 1954. He went to the Deutsche Schule
(German School, and Germans should be aware of this when talking in his presence in their mother tongue) in Barcelona and later
entered the School of Medicine at the University of Barcelona. His
original interest focused on Pathology and Internal medicine.
During his residency he passed the Boards in Internal Medicine
and in Digestive Diseases and eventually landed at the Liver Unit
of Prof. Rodés. There, Jaume Bosch was his mentor and he did his
PhD with him. When hired in 1986 he started the liver cancer
group and founded BCLC together with Dr. Brú. The group rapidly
expanded to incorporate a pathologist (Manel Sole) a surgeon
(Josep Fuster) and an abdominal radiologist for CT and MR

Received 21 December 2015; accepted 21 December 2015
E-mail address: galle@mail.uni-mainz.de

(Carmen Ayuso). Later on they were joined by a series of
interventional radiologists such as Xavier Montanyà and Maribel
Real, later followed by Lluis Bianchi, Ramon Vilana and
Marta Burrel. The group is now too large (Fig. 4) to detail all
components, but can be recognised in the picture and at www.
bclc.cat.
From the beginning the group incorporated fellows to be
trained and who ultimately became major players in the field
of HCC: Xavier Calvet, Antoni Castells, Loreto Boix, Josep M Llovet,
Ramon Vilana, Marta Burrel, Margarita Sala, Carolina Armengol,
Maria Varela, Maria Reig, Alejandro Forner, all of whom did seminal clinical contributions in highly cited manuscripts and ultimately got a stable position within the BCLC or in other
hospitals. The BCLC was also a terrain to train foreign fellows
from all over the world. In addition, over the years the group
established a translational research lab coordinated by Josep M.
LLovet who has generated an impressive amount of data about
molecular profiling in this disease.
In the early days, Japan was amongst the leading countries in
the HCC field, facing a higher disease burden compared to the
West. Jordi wisely appreciated this lead and spent a fellowship
period (1990) in Japan at the National Cancer Center in order to
gain knowledge and expertise. There he met and worked with
the eminent scientists Masatoshi Makuuchi and Kenichi
Takayasu, while also meeting Masamichi Kojiro in Kurume. These
interactions were instrumental in gaining insight and forming his
own view of HCC.
A very important period in Jordi’s life – both scientifically and
as a human being – was his work as visiting professor 1995–97 in
Seattle in the lab of Nelson Fausto at Washington University.
Nelson and Jordi became friends and Jordi became an expert in
liver regeneration, in priming of hepatocytes by cytokines and
in hepatocarcinogenesis. This resulted in one of the first studies
on molecular signatures [1]. It is noteworthy to mention that
Jordi early on contributed to the assessment of biomarkers which
later proved to be prognostic and have the potential to be predictive such as cMET [2] and others [3].
It would go beyond the scope of this editorial to list all his
contribution to HCC and clinical hepatology but the most important ones ought to be addressed:
These includes the world’s first description on the
relationship between HCV and HCC [4], the identification
of portal pressure as a key criterion for the selection of
surgical candidates [5], the development of the BCLC system

Journal of Hepatology 2016 vol. 64 j 998–1000

 JOURNAL OF HEPATOLOGY
as a staging/treatment indication algorithm [6], the proposal
and validation of non-invasive HCC diagnostic criteria [7],
and the demonstration of the benefits of chemoembolization
in HCC patients [8]. And of course, most importantly the
demonstration of the benefits of sorafenib for patients with
advanced HCC [9].
Further work included the creation of a tumor tissue collection and of cell lines together with Loreto Boix that allowed the
pursuit of molecular studies.
In addition to scientific and clinical engagement Jordi was and
is involved in many organizations and societies, some of which
still bear his mark today. During his term as EASL’s Scientific
and Administrative Secretary, EASL abandoned local organization
committees and moved to centralized control. Through
educational grants from biomedical industries the EASL School
of Hepatology and also the EASL Monothematic and Consensus
conferences became reality. Indeed, the seminal one that paved
the model was the EASL HCC Barcelona conference, which
resulted in the first EASL Guidelines [10].
Later he founded the International Liver Cancer Association
(ILCA), the only international organisation devoted exclusively
to liver cancer research for experts from all related disciplines.
ILCA had its first annual conference in 2007 under his Presidency
and is approaching its 10th annual conference in September 2016
in Vancouver. After 10 years of existence ILCA today plays the
role of the number one international conference on primary liver
cancer.
Behind this hard work and great success is a human being:
Jordi is married to Teresa Fusté, they have a daughter, Tanit,
and two sons: Gerard and Albert. Tanit is married to Eric and
has three children Jerry, Jordi and Julia. Here the logical structure,
visible in Jordi’s scientific work, continues: All three names start
with J followed by B as middle name, J – B – B for Bruix, of course!
Jordi and Teresa can now take on another important role, being
grandparents.
Jordi and Teresa are a wonderful and respectful couple and
those of us who have lost against Jordi in a discussion, enjoy
Teresa telling him how to behave very much. Jordi likes traveling,
more and more together with Teresa as she recently retired, giving them more time as a couple. He appreciates to read a good
book, particularly when sitting in front of a fireplace. He regrets
having cut down on sailing, playing tennis and walking outdoors
– a concession to his sometimes hectic life.
Jordi and Teresa love to share time with friends and provide
them with advice if visiting Catalonia. Here Jordi proves to be a
professional tour guide: his Catalonian pride, knowledge of the
country and his passion for good food and wine are solid guarantees for splendid encounters. Plans are typically made over a good
dinner and travel is facilitated by his old VW Golf with undefined
CO2 production. He is, not always visible at first glance, a truly
warm-hearted human and part of his success is his capability
to build-up networks of scientists who happen to be friends:
Morris Sherman, Vincenzo Mazzaferro, Michel Beaugrand, Pietro
Majno, Riccardo Lencioni, Masamichi Kojiro, Greg Gores, Bruno
Sangro, Massimo Colombo, and others belong to this network of
friends and I am proud to be part of it.

Fig. 1. Jordi Bruix.

Fig. 2. Dr. Bruix (third from left) and Dr. C. Brú (first from left).

Journal of Hepatology 2016 vol. 64 j 998–1000

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 Editorial
HCC

Prognosis

Very ealy stage (0)
Single ≤2 cm
Child-Pugh A, PS 0

Early stage (A)
Single or 3 nodules ≤3 cm
Child-Pugh A-B, PS 0

Potential candidate for liver
transplantation

No

Yes

Single
Portal pressure
bilirubin

Associated
diseases
No

Treatment

Advanced stage (C)
Terminal stage (D)
Portal invasion
Child-Pugh C**
Extrahepatic spread
PS 3-4
Child-Pugh A-B*, PS 1-2

3 nodules ≤3 cm

Normal Increased

Ablation

Intermediate stage (B)
Multinodar
Child-Pugh A-B*, PS 0

Resection

Yes

Transplant

Ablation

TACE

Sorafenib
BSC

Curative treatments

Palliative treatments

* Note that Child-Pugh classification is not sensitive to accurately identify those patients with advanced liver failure that would deserve
liver transplant consideration
** Patients with end stage cirrhosis due to heavily impaired liver function (Child-Pugh C or earlier stages with predictors of poor
prognosis, high MELD score) should be considered for the liver transplantation. In the, HCC may become a contraindication if exceeding
the enlistment criteria.
Fig. 3. The BCLC staging and treatment system.

References
You may visit www.bclc.cat for further information

Fig. 4. The BCLC as it currently stands. Next to and left of Dr. Bruix, Dr. C. Brú,
the co-founder of the group. Note the Catalonian flag in the back.

Conflict of interest
The author declares the following disclosures: Speaker/Consultant: Bayer, BMS, MSD, Lilly, SillaJen, Sirtex, Merck Serono.

1000

[1] Smith MW, Zhaoxia YN, Marcus K, Hao D, Boix L, Fausto N, et al. Hepatitis C
virus and liver disease: global transcriptional profiling and identification of
potential markers. Hepatology 2003;38:1458–1467.
[2] Boix L, Rosa JL, Ventura F, Castells A, Bruix J, Rodés J, et al. C met mRNA
overexpression in human hepatocellular carcinoma. Hepatology 1994;19:88.
[3] Boix L, Bruix J, Campo E, Solé M, Castells A, Fuster J, et al. Nm23 H1
expression and disease recurrence after surgical resection of small hepatocellular carcinoma. Gastroenterology 1994;107:486–491.
[4] Ampurdanés S, Forns X, Castells A, Saiz JC, Costa J, Bruix J, et al. Hepatitis C
virus (HCV) genotypes in Spanish patients with HCV infection: relationship
between HCV genotype 1b, cirrhosis and hepatocellular carcinoma. J Hepatol
1997;27:959–965.
[5] Forner A, Bruix J. East meets the West—portal pressure predicts outcome of
surgical resection for hepatocellular carcinoma. Nat Clin Pract Gastroenterol
Hepatol 2009;6:14–15.
[6] Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC
staging classification. Semin Liver Dis 1999;19:329–338.
[7] Forner A, Vilana R, Ayuso C, Bianchi L, Solé M, Ayuso JR, et al. Diagnosis of
hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the
noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology
2008;47:97–104.
[8] Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, et al. Arterial
embolization or chemoembolization versus symptomatic treatment in
patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002;359:1734–1739.
[9] Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in
advanced hepatocellular carcinoma. N Engl J Med 2008;359:378–390.
[10] Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs A, et al.
Clinical management of hepatocellular carcinoma: Conclusions of the
Barcelona-2000 EASL Conference. European Association for the Study of
the Liver. J Hepatol 2001;35:421–430.

Journal of Hepatology 2016 vol. 64 j 998–1000