Hmm strange,i didn't had such problems. Must be the v sink,because that is the only different option between us, i always turn it off.
I have it off, I use a g-sync monitor.
I always cap my frame rate to whatever bottom minimum frame rate that I get. hypothetical example: say I'm playing a game and it chugs inside towns and drops to 48fps, but outside I can get 100fps, well then that means I cap it to 48fps and I play it at 48fps.
100+fps 95% of the time dropping to 70 in big cities is far less noticeably bad than running at 70 all the time.
Game has memory leak when you play it couple of hours so if your frame rate sinks and/or your game becoming choppy just restart it from windows. I am playing dumb character now its really funny at moments, missed that assistant can be saved guess this little game has a bit of hidden C&C after all but I am there for loot and bitches (and bitches prefer to hook with other bitches) so got there two hours or so after receiving the quest.
This isn't my experience, as it shoots right back up to 100-120fps when I leave said city. It's well known the game runs worse in those bigger cities, not sure why I'm getting pushback. It's pretty common in games of this type in general. I'm not complaining about getting 70-80fps in those areas, I'm saying if you are aiming for a solid 60fps on a 60hz monitor those areas will be your 1% lows.