<p>Neuroblastoma (NB) is the most prevalent extracranial solid tumor in children, with a survival rate of approximately 50% for those in the high-risk category. Oxidative stress is a well-known contributing factor in various diseases, including cancer; however, the relationship between systemic oxidative stress and the prognosis of NB remains unclear. This study aims to analyze the correlation between oxidative stress and the clinical characteristics of NB, along with its significance for the prognosis of the disease. This study involved 671 NB patients. We analyzed the relationship between systemic oxidative stress and the clinical features or prognosis of NB. A prognostic nomogram was developed based on indicators of systemic oxidative stress, employing Cox regression analysis. To validate the prognostic nomogram for NB, we utilized time-dependent receiver operating characteristics (ROC) curves, calibration curves, and decision curve analysis (DCA). The systematic oxidative stress score (SOS) was developed using three biomarkers of oxidative stress: serum albumin (ALB), total bilirubin (TBIL), and lactate dehydrogenase (LDH). Patients classified in the high SOS group exhibited a poorer prognosis. Multivariate Cox regression analysis indicated that SOS served as an independent prognostic factor for NB. A nomogram incorporating SOS and relevant clinical characteristics demonstrated a high accuracy in predicting the prognosis of NB patients. Furthermore, the results from time-dependent ROC curves, calibration curves, and DCA revealed that the nomogram significantly outperformed traditional prognostic indicators. SOS is identified as an independent prognostic indicator for NB patients. The nomogram incorporating SOS demonstrates potential in predicting outcomes and may provide additional information to support clinical decision-making, but its clinical utility needs independent validation.</p>