Purpose <p>To evaluate the prognostic value of baseline [⁶⁸Ga]Ga-DOTA-NOC PET/CT-derived volumetric and uptake parameters in paediatric neuroblastoma patients.</p> Methods <p>Sixty‑five newly diagnosed patients underwent baseline [⁶⁸Ga]Ga‑DOTA‑NOC PET/CT. Primary‑tumour and whole‑body metrics were measured: SUVmax, SUVmean, SUVpeak (standardized uptake values), Gross Tumour Volume (GTV), and Total Lesion NOC (TL‑NOC). Cox regression evaluated predictors of progression‑free survival (PFS) and overall survival (OS).</p> Results <p>Over a median 30‑month follow‑up (range 10–51), 20 progressed and 11 died. High‑risk cases (<i>n</i> = 38) had higher uptake and volumes than non high‑risk (<i>n</i> = 27): primary‑tumour and whole‑body SUVmax (<i>p</i> = 0.006 and 0.001); primary‑tumour SUVpeak (<i>p</i> = 0.013); whole‑body TL‑NOC(<i>p</i> = 0.001) and GTV (<i>p</i> = 0.016). On multivariable Cox analysis, primary‑tumour SUVmax (HR = 1.07, 95% CI: 1.02–1.12, <i>P</i> = 0.005) and SUVpeak (HR = 1.06, 95% CI: 1.01–1.11, <i>P</i> = 0.025), as well as whole‑body TL‑NOC (per 100 SUV × cm³; HR = 1.03, 95% CI: 1.01–1.05, <i>P</i> = 0.013), remained independently associated with PFS, whereas whole‑body TL‑NOC (per 100 SUV × cm³; HR = 1.07, 95% CI: 1.03–1.10, <i>P</i> = 0.001), whole‑body GTV (per 50 cm³; HR = 1.08, 95% CI: 1.01–1.16, <i>P</i> = 0.028) and primary‑tumour TL‑NOC (per 100 SUV × cm³; HR = 1.08, 95% CI: 1.01–1.15, <i>P</i> = 0.026) were independent predictors of OS. A whole‑body TL‑NOC &gt; 1357.05 SUV × cm³ identified patients with significantly worse PFS and OS.</p> Conclusion <p>Parameters derived from [⁶⁸Ga]Ga‑DOTA‑NOC PET/CT, especially whole‑body TL‑NOC, are independent predictors of PFS and OS in neuroblastoma, supporting their use for risk stratification.</p>