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 NB initiation and progression 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 NB pathogenesis. To deepen the understanding of NB, this article systematically reviewed key regulatory factors and their research progress from three dimensions: tumor development process (including abnormal proliferation, migration, invasion, and EMT), inflammatory response, and cell apoptosis. We exhibited the regulatory mechanisms of genes including MYCN, ALK, BDNF, and PHOX2B on the malignant biological 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 not only deepen our understanding of the molecular pathological mechanisms of NB, but more importantly, reveal multiple therapeutic targets with translational potential, providing systematic theoretical references for basic research and clinical treatment of NB. Moreover, they also promote the research process from molecular mechanisms to clinical translation, ultimately aiming to improve the prognosis of pediatric patients.