Proof of PID implies genus $0$.
Let $U$ be the affine curve defined by $R$. It is smooth. Let $C$ be the unique projective smooth curve containing $U$ as an open subset. We want to show that $C$ has genus $0$. Let $F=C\setminus U=\{x_1, \dots, x_n\}$. Then we have an exact sequence involving divisor groups
$$ \oplus_i \mathbb Z x_i\to \mathrm{Cl}(C) \to \mathrm{Cl}(U) \to 0 $$
where Cl means Weil divisors modulo linear equivalence. The right hand side map is the natural restriction and the LHS is given by $\sum_i a_ix_i \mapsto \sum_i a_i[x_i]$. The sequence is exact because any divisor in $U$ extends to $C$ with zero coefficients on the $x_i$'s, and if $D$ is a divisor on $C$ which is $0$ in $\mathrm{Cl}(U)$, then $D$ is linearly equivalent to a divisor $D'$ with support in $F$, so $D'=\sum_i a_i[x_i]$.
Now if $R$ is a PID, then $\mathrm{Cl}(U)=0$, hence $\mathrm{Cl}(C)$ is finitely generated over $\mathbb Z$. But it contains the Jacobian $J=\mathrm{Cl}^0(C)$ of $C$. If $g(C)>0$, then $J$ has positive dimension and has infinitely many point of finite order, this contradicts the property of being finitely generated over $\mathbb Z$. So $g(C)=0$. This reasoning holds over any algebraically closed field. Over $\mathbb R$, one can argue that $J$ contains a real Lie group of positive dimension, hence is uncountable and can't be finitely generated. Over a general field $R$ being PID doesn't imply genus $0$ (example : $C$ an elliptic curve over $\mathbb Q$ such that $C(\mathbb Q)$ has only one point, take $U$ be the complement of the origin of $C$).
Note that over an algebraically closed field $k$, once we proved $C$ has genus $0$, this implies that $U$ is isomorphic to an open subset of the affine line, so $R\simeq k[t, 1/Q(t)]$ for some non-zero polynomial $Q(t)\in k[t]$.
An interesting question would be to characterize $R$ being a PID directly in terms of $P(X,Y)$. Some sufficient conditions are $P(X,Y)$ has degree $1$ in $X$ or in $Y$, or $P(X,Y)$ has total degree $2$. I don't know whether there are other possibilities.
Edit I think it is hard to decribe PID in terms of $P(X,Y)$. Any automomorphism of $\mathbb C[X,Y]$ with give a $Q(X,Y)$ defining a PID, but with $Q(X,Y)$ of different shape. For example, $X-Y^3$ can be transformed into $X-(Y+X^3)^3$ which also defines a PID, but it has degree $>2$ in $X$ and in $Y$. As the automorphism group of $\mathbb C[X,Y]$ is huge, I don't think there is a simple statement on $P(X,Y)$ which is equivalent to $R$ being a PID.