There was a significant association between IGF1R/PCNA and Rad18/PCNA signal intensity (p = 0.039) and clusters (p = 0.041) in the primary (adnexal) tumor, but not in the metastatic lesions (p = 0.125 and p = 0.263) suggesting that HGSC metastases may have undergone alterations of the DNA damage tolerance pathway such as activating IGF1R independent PCNA phosphorylation. Here, PCNA is linked to neoplasm.