Neuroblastoma (NB) is the most common extracranial solid tumor in children, characterized by high mortality and poor prognosis. With advances in molecular biology and genomics research, it has become increasingly clear that the development and progression of NB are driven by the dysregulation of complex molecular networks. To develop safer and more efficient precision diagnostic and therapeutic strategies, it is particularly important to gain a deeper understanding of the molecular mechanisms underlying the pathogenesis of NB. This article systematically reviews research progress on key regulatory factors from three dimensions: tumor development (including abnormal proliferation, migration, invasion, and EMT), inflammatory responses, and apoptosis. We examined the effects of various genes, including MYCN, ALK, BDNF, and PHOX2B, on malignant behaviors of NB cells, analyzed the tumor-promoting effects of inflammatory signals, including NF-κB, COX-2/ PGE2, MyD88, and HMGB1, and illustrated the mechanisms of apoptosis-related factors, including the Bcl-2 family, p53-MDM2 axis,and TRAIL. These findings deepen our understanding of the molecular pathological mechanisms of NB, and more importantly, reveal multiple therapeutic targets with translational potential, providing systematic theoretical references for basic research and clinical treatment. More broadly, this review is expected to promote further research from molecular mechanisms to clinical translation, ultimately aiming to improve the prognosis of pediatric patients.