Oniisama e...

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Both of them are shoujo mangas from the 70s, with a tragic and touching ending that you'll remember forever. 

Both Oniisama e...and Pieta revolve around sexuality, and delve into issues such as parental abandonment, self harm, and mental illness. Also, the flashbacks involving the private school with Sahoko and Rio remind me a bit of Oniisama e, what with the schoolchildren with fancy haircuts and gossiping about Rio's private life. 

Both manga were created by Ikeda Riyoko and therefore are naturally quite dramatic. Both have main heroes/heroines that while being physically female dress and act like males (one even identifies as a male). Also both experience unrequited love and intense longing while their ending is similar and heartbreaking. 

Both are shoujo manga about the life of students in an all-girls school. Although Onii-sama e... is a bit more dramatic and deals with some heavy topics, both manga portray the complicated relationships girls have during their teenage years, be it with love interests, friends or family.